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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416986
Report Date: 08/10/2022
Date Signed: 08/10/2022 04:10:46 PM


Document Has Been Signed on 08/10/2022 04:10 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CHILDREN'S COLLECTIVE, INC. CASA DOMINGUEZ, THEFACILITY NUMBER:
197416986
ADMINISTRATOR:BACH, ROCIOFACILITY TYPE:
830
ADDRESS:15711 S. ATLANTIC AVETELEPHONE:
(310) 637-1593
CITY:E. RANCHO DOMINGUEZSTATE: CAZIP CODE:
90221
CAPACITY:26CENSUS: 0DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Natasha Crowder-StallworthTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPAs) Warren Birks and Pat Medel conducted an unannounced Required 1 year inspection. LPA met with Site Supervisor Natasha Crowder-Stallworth who guided analyst on tour of the facility. This is a infant-toddler program serving 12 infants (birth to 18 months) and 14 toddlers 18 moths to 36 months. The program is physically separate from a preschool program housed on the campus. The facility operates Monday through Friday from 7:30 AM to 5:00 PM.

At approximately 1:50pm all areas identified on the Facility Sketch were inspected. LPA observed the following teacher-child ratios during the inspection: Toddler Room: (zero teachers and zero infants), Infants Room (zero teachers and zero infants). Teacher-child ratios appeared to be in compliance and staff fingerprints have the required clearance at this time. School was closed due to half-day.

LPA observed all furniture and equipment was inspected for age appropriateness and good repair, telephone service, heating, lighting and ventilation were observed to be adequate. Storage for infants’ belongings and napping equipment/cribs were inspected and found to meet all regulatory requirements at this time. The facility uses indented changing pad with 3 inch sides.LPA advised Site Supervisor to use equipment that is separate from changing pad (facility has been using these pads since inception). The padding at least one inch thick and sides at least three inches high. The changing area is also within arm’s reach of a hand washing sink. LPA observed toys to be clean and appear age appropriate. LPA observed first aid kits kept in each classroom. Carbon monoxide detectors and smoke detectors are present in the facility. 2A10BC Fire extinguishers are due for service in Dec 2022.

Hazardous items including including medicine and cleaning compounds are stored inaccessible areas such as high cabinets and/or storage rooms. At this time, the office is used as an isolation area. There are portable cots and changing mats for infants to rest and be changed if needed. The facility provides Breakfast, Lunch and a PM snack from an outside vendor. Some parents provide breast milk for infants.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S COLLECTIVE, INC. CASA DOMINGUEZ, THE
FACILITY NUMBER: 197416986
VISIT DATE: 08/10/2022
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The facility provides sheets and blankets and they are laundered daily. Food preparation areas were toured for safety, cleanliness and proper equipment. There are adequate amount of snacks and food in the kitchen.

Outdoor equipment was inspected for safety, cushioning material, good repair, and age appropriateness. LPA observed the outdoor play area to be physically separate from the preschool play area. The playground and equipment was inspected for safety, cushioning material, good repair and age appropriateness. LPA observed the playground to have required shade and adequate fencing. The playground has weighted canopies for shade. There were no bodies of waters and no appearance of immediate hazards on the playground. LPA observed the play area appear to be free of hazards and bodies of water. LPA Birks reminded Site Supervisor that Infants need to be have direct care and supervision, including visual supervision of staff at all times.

Note: The facility has been using an indented changing pad with sides that are higher than three inches. LPA advised Site Supervisor Stallworth to use equipment with three inch sides that are separate from the pad.

LPA evaluated care and supervision and determined the basic needs of infants and toddlers were met. LPA observed digital Sign in and Sign out records to be complete. LPA conducted a Children's Records Review to ensure children files are complete and have the proper forms (such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights, Needs and service plans, Infant safe sleep etc. and children's roster is current).

At approximately 2:30pm LPA reviewed Staff Records to ensure: All individuals present have obtained a criminal record clearance or criminal record exemption, education requirements, Criminal Record Clearance documents available, verification CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza (or flu declination available). LPA observed at least one staff member to have current CPR (Expiration 2024). LPA to review more staff records at a later date.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S COLLECTIVE, INC. CASA DOMINGUEZ, THE
FACILITY NUMBER: 197416986
VISIT DATE: 08/10/2022
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There is drinking water in each classroom and children have their names labeled on their bottles. Formula and breast milk have labels (along with child information listed) to distinguish one from the other.

The following was discussed with the Site Supervisor Natasha Crowder-Stallworth: Recently Approved Safe Sleep Regulations in Effect (PIN 20-24-CCP). LPA also provided advised to sleep infants on their backs and check on them at least every 15 minutes. LPA emailed a copy of PIN 20-24-CCP.



Rooms that are off-limits need to always be inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excer-saucers or any other item that falls into that category are allowed in facility. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.


Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Last drill conducted July 2022. Role and responsibilities of being a Mandated Reporter were reviewed. The Site Supervisor was advised how to access forms and Regulations online at www.ccld.ca.gov. Site Supervisor was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA advised Site Supervisor that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. Records for all children and staff must be maintained for three (3) years after separation from the facility. The Site Supervisor was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation.

Exit interview was conducted with Site Supervisor Natasha Crowder-Stallworth. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022
LIC809 (FAS) - (06/04)
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