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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419385
Report Date: 06/17/2021
Date Signed: 06/17/2021 12:43:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:TUPPER TOBIAS VILLAGE CHILD CARE CENTERFACILITY NUMBER:
197419385
ADMINISTRATOR:LORENA HERNANDEZFACILITY TYPE:
830
ADDRESS:9273 TOBIAS AVENUETELEPHONE:
(747) 236-7012
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:18CENSUS: 9DATE:
06/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Lorena Hernandez, DirectorTIME COMPLETED:
12:46 PM
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On 06/17/2021 Licensing Program Analyst (LPA), Shandra Powell conducted an unannounced Annual Required Inspection for the Infant License. LPA met with Director, Lorena Hernandez, and toured the facility indoors and outdoors. Days and hours of operation are Monday thur Friday 6:30am to 6:00pm. At the initial start of the inspection LPA observed Alfred Augustine, (Speech Therapist) from ECA (Every Child Achieves) interacting with child #5 alone on the front side of the facility where sandbox is located. LPA observed 9 children present during inspection. There is no swimming pool or other bodies of water on the premises, however LPA did observe a wading pool in restroom. Director stated the pool has not been used and will check Department of Public Health website for instructions on using a wading pool during child care hours. LPA advised director to always empty wading pool after each use. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked shed in the storage area. LPA observed all poisons stored in a locked shed outside of facility.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TUPPER TOBIAS VILLAGE CHILD CARE CENTER
FACILITY NUMBER: 197419385
VISIT DATE: 06/17/2021
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Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. LPA observed a refrigerator to store foods/beverages. Director stated breakfast and lunch and snack are provided by Licensee "Around The Corner Center For School Age Enrichment" each day. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All materials and surfaces accessible to children are toxic free. Outdoor activity space surfaces are free of hazards. The facility is free of flies, insects and rodents. There is a working carbon monoxide detector. 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. All staff present have received a criminal record clearance or exemption. No individuals excluded by the Department are allowed to be present. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TUPPER TOBIAS VILLAGE CHILD CARE CENTER
FACILITY NUMBER: 197419385
VISIT DATE: 06/17/2021
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The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care. LPA reviewed children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child, medical assessment. LPA reviewed staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements. Menus are posted at least one week in advance where an authorized representative can view them. Infant changing tables have a padded surface and are covered with washable vinyl or plastic and have raised sides at least three inches high. Toys observed are safe with no sharp points, edges or splinters and are without small parts that can be pulled off and swallowed. The facility has sufficient cots for infant napping. There is indoor and outdoor activity space for infants that is physically separate.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TUPPER TOBIAS VILLAGE CHILD CARE CENTER
FACILITY NUMBER: 197419385
VISIT DATE: 06/17/2021
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Each cot is occupied by only one infant at time with each child's name. LPA observed documentation(LOG) during inspection for staff physically checking on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Staff-infant ratio requirements are being met while infants are sleeping.

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 cited. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Lorena Hernandez, Director. Appeal Rights provided.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021
LIC809 (FAS) - (06/04)
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