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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416919
Report Date: 03/22/2023
Date Signed: 03/22/2023 12:35:58 PM


Document Has Been Signed on 03/22/2023 12:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:SPIRIT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
197416919
ADMINISTRATOR:KEENA TAYLORFACILITY TYPE:
850
ADDRESS:4061 WEST WASHINGTON BOULEVARDTELEPHONE:
(323) 737-2467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:60CENSUS: 36DATE:
03/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Keena Taylor, Facility RepresentativeTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs) Denise Gibbs and Rosaura Valenzuela conducted an unannounced annual required inspection at the above facility on 3/22/23 at 10:00AM. LPA met with Keena Taylor, Facility Representative (FR).

This is a preschool program which consists of five classrooms, Dragonfly (2 classrooms), Lady Bug, Bumble Bee, and Butterflies. Facility operation hours are Monday to Friday from 6:45 AM to 6:00 PM. This facility houses an early Intervention program (referred by Regional Center). This facility is also associated with Spirit Early Intervention Program (Infant center) #198013696 housed at another location. There were 30 children and eight staff present when LPAs arrived. Facility is in compliance with license capacity and Title 22 ratio guidelines. All individuals present have obtained a criminal record clearance.

LPAs toured All classrooms. Classrooms had furniture in good condition, free of loose, sharp and/or pointed parts. LPAs observed the small rug in the Dragonfly class, on the left side of the facility, is off colored and has dark spots. Per FR, rugs are cleaned every two weeks but with the rainy weather, dirt has been tracked in the classroom. LPAs did not observe any tripping hazards in the classrooms. Water is made readily available in each classroom via pitchers and cups provided by the facility. LPAs reminded FR that water pitchers should be filled at all times so that children can drink freely. Facility does have central, operable water fountain but it is not used. Children have cubbies to store personal belongings separate from each other. Children have cots for napping. Sheets are provided by facility and washed weekly. Blankets are brought from home and washed weekly. Per FR, children's medication is stored in the classroom on a high shelf, inaccessible to children. LPAs reviewed storage, expiration dates and documentation for medication. While touring the classrooms, LPA's observed towels along the baseboards in a section of the Butterfly classroom. Per staff, they have been having an issue with the rain and water damage. A section of the classroom was observed to be blocked off for the safety of the children. Per staff this classroom currently has
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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SPIRIT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 197416919
VISIT DATE: 03/22/2023
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low numbers to occupy the space. FR provided LPAs with an invoice for water damage repair and an Unusual Incident Report. LPAs reminded FR, that all unusual incident must be reported within 24 hours.

LPAs toured the children’s restrooms located through the Dragonfly classroom on the left side of the facility. LPAs observed the restroom to be safe and sanitary with five operable toilets and four operable sinks. The restroom also has a changing table. LPAs observed cleaning supplies stored under the locked changing table, inaccessible to children.

LPAs observed that there is a waiver on file for stagger play. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing equipment to absorb fall. Shade was observed throughout the outdoor area. Due to rainy weather outdoor area was not set up for play. An operable water fountain was observed outdoors.

LPAs observed required posted documentation in the facility entrance, which included, Facility License, waiver for outdoor play, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights and Lunch/Snack Menu. All documents were observed.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 2/27/23. All documents were observed.

LPA reviewed Sign In/Out sheets, located inside the main entrance, before entering the classrooms. All children present were signed in with date, time and full signature of the child's representative.

LPA toured the kitchen located adjacent to the Dragonfly (left side) classroom. Facility provides Breakfast, AM snack, PM snack and lunch. Food is prepared at facility. Kitchen was observed to be clean, free of litter, insects and rodents. Trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food. Per FR carbon monoxide detector is combined with facility smoke and fire alarm system.

Children’s records were reviewed for Licensing Form (LIC) 700 Emergency Card, Immunization Records, LIC 627- Consent for Medical Treatment, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All documents complete. ----------------PAGE 2
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SPIRIT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 197416919
VISIT DATE: 03/22/2023
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Staff records were reviewed for approved Pediatric First Aid and CPR certification for at least one staff member on site, LIC 9052- Employee Rights, LIC 501- Personnel Record, LIC 503- Health Screening Report, LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts and current Mandated Reporter Training Certificate. All documents complete.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

Per FR, facility is not required to conduct water lead testing due to the facility being built after Jan, 1 2010. LPAs observed the Certificate of Occupancy, certified 10/12/2010.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA's observations and records review no deficiencies will be cited today 5/27/22.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SPIRIT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 197416919
VISIT DATE: 03/22/2023
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Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Facility Representative, Keena Taylor

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7