197418419-12-13-2022-58-CC-SORS-CM42N2-20221213163202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418419
Report Date: 12/13/2022
Date Signed: 12/13/2022 04:32:12 PM

Document Has Been Signed on 12/13/2022 04:32 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BALBOA GIFTED MAGNET STAR		FACILITY NUMBER:	197418419
ADMINISTRATOR:	STEPHANIE TREJO		FACILITY TYPE:	840
ADDRESS:	17020 LABRADOR STREET		TELEPHONE:	(310) 386-6359
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	90	CENSUS: 39	DATE:	12/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Gabriel Thompson- Director		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 12/12/2022 Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced Annual Required Inspection for the facility. LPA met with Gabriel Thompson, Director and toured the facility indoors and outdoors. LPA observed The “STAR Inc." program operates after school off of the Balboa Gifted Magnet Star site utilizing bungalows 32 and 33. LPA observed all required postings in a prominent area. LPA observed 39 children and 4 adults. The program operates from 2:30pm to 6pm on Monday, Wednesday, Thursday, Friday, and 1:30pm to 6:00pm on Tuesday .Center does not operate during the summer/winter break. Children Sign-In According to the Site Director: Monday through Friday: Afterschool, staff sign them in and parents sign them out when being released to go home. All children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. A walk through of the classroom area was conducted. LPA observed 2 licensed classrooms on the premises. Classroom space was found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. There is adequate heating, lighting and ventilation. Drinking water is readily available in each classroom. LPA observed classroom space to have arts/crafts, reading, storage and learning activities. There are 3 first aid kits in classroom 33 located in a storage closet. LPA observed adequate arrangements for isolation and care of ill children located in each classroom next to the sink areas. The restroom and toileting areas were inspected. Program uses the schools boys and girls restrooms to accommodate the facility’s capacity. Girls restroom consists of 5 toilets and 3 sinks, boys restroom consists of 4 urinals 3 toilets and 3 sinks. Toilets flush properly, toilet and sinks are reachable by the children in care.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BALBOA GIFTED MAGNET STAR	FACILITY NUMBER: 197418419
	VISIT DATE: 12/13/2022

NARRATIVE

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The restrooms have adequate toilet paper and paper towels available. The restrooms were found to be clean. There is adequate lighting/ventilation in the bathroom area.

RM 32 (1^st - 2^nd) /RM 33: (3^rd- 5^th)
All areas identified on the Facility Sketch were inspected.
RM 32: 17 children with a ratio of 2 teachers
RM 33: 22 children with a ratio of 2 teachers

Playground equipment is in safe condition and free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The surface of the outdoor activity space is maintained in a safe condition or free of hazards. All food preparation and storage areas are clean and safe. Per Director, program does not provide daily snacks for children. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is readily available both indoors and outdoors. The facility is equipped with a working smoke detector and carbon monoxide detector in both classrooms. LPA observed a fire extinguisher (2A 10BC) located in both classrooms serviced 1/2022. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.

LPA reviewed a sample of children’s files and observed files were complete. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPA reviewed a sample of staff files and observed files were complete.

LPA informed director about New Center Director Documents that need to be submitted to the department within the next 30 days and provided director with a copy of the regulation.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BALBOA GIFTED MAGNET STAR	FACILITY NUMBER: 197418419
	VISIT DATE: 12/13/2022

NARRATIVE

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Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are being cited.
Licensee was provided a copy of their appeal rights. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC809 (FAS) - (06/04)

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