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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419969
Report Date: 02/02/2024
Date Signed: 02/02/2024 02:04:51 PM


Document Has Been Signed on 02/02/2024 02:04 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:GOT GAME SPORTSFACILITY NUMBER:
197419969
ADMINISTRATOR:KALMAN, KOREYFACILITY TYPE:
840
ADDRESS:408 FAIRFAX AVENUETELEPHONE:
(310) 975-8524
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY:132CENSUS: 0DATE:
02/02/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Mahrischra MedinaTIME COMPLETED:
02:20 PM
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On 02/02/2024 , at 11:20 am ,Licensing Program Analyst`s (LPA`s) Shushanik Safaryan and Anomeh Eivazian conducted an unannounced required 3-year inspection. A COVID-19 risk assessment was conducted prior to entering the facility. The facility is located on a Hancock Elementary School (LAUSD) school site. At 11:30 am LPA`s met with Facility Representative Mahrish Medina, who guided the LPA `s on a tour of the facility. Program uses the one classroom #27, auditorium , cafeteria as the indoor space and all areas of the playground for outdoor activities. This is a school age after-school program from: Monday- Wed, Thursday, and Friday from 2:15 pm to 6:00 pm and Tuesday 1:15 pm to 6:00 pm.. Per Facility Representative there are 85 children enrolled.

No children were present during the inspection.
LPA observed all required forms/publications in the binder available for the parents.

At 11:40 am during the tour LPA`s observed program uses classroom #27 which was not approved by Child Care Licensing and Department doesn’t have fire clearance and Facility did not report any changes to licensing to update facility sketch. Per Facility Representative program has moved to Room #27 since sometimes in 2021. Per Facility Representative program will move back to classroom #26 and will submit required paperwork to licensing to update the sketch and add Room #27 as licensed area.

The classroom furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free.

At 11:45 am LPA`s observed red and blue carpet in the classroom #27 with black stains and dust. (Picture was taken). Per Facility Representative children sometimes sit on it for the circle activities. Per Representative carpet was vacuumed yesterday and washed beginning of the year. Per Representative carpet will be removed or will be replaced with the new one .


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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOT GAME SPORTS
FACILITY NUMBER: 197419969
VISIT DATE: 02/02/2024
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Children use school bathrooms ; waiver is on the file . All toilets and washing facilities are in safe and sanitary operating conditions. First Aid supplies are available in the classroom and were complete.

Per Facility Representative children don’t nap and no lunch provided. Program provides pm snack only. Snack menus are posted one week in advance where it is visible by the child's authorized representative. Snacks were reviewed for availability, quantity, and appropriateness to children in care. LPA`s observed refrigerator in the classroom which is used by program to keep snacks. Dry snacks are kept in the cabinets located in the classroom #27. LPA`s did not observe any cleaning compounds/solutions stored with the food.

LPA observed that there are functioning smoke and carbon detectors in the classroom. LPA observed a fully charged and serviced fire extinguisher with the service date 09/06/2023. Last Emergency disaster drill was conducted on 02/01/2024. Facility Representative states there are no weapons, firearms, or bodies of water on the premises and LPAs did not observe any.

All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors. Per facility representative, children can use filtered water fountain located in the playground or bottled water provided by program. The facility was observed to be free of flies, other insects, and rodents.

There is an outdoor space immediately outside the auditorium with benches and tables that is being used for outdoor activities and/or eating snacks. Per program representative children are not allowed to use the yellow and green play equipment (monkey bars), as well as the monkey bars on the purple equipment There are no bodies of water on the premises and the outdoor space is completely fenced in.

Outdoor 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 areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.


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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOT GAME SPORTS
FACILITY NUMBER: 197419969
VISIT DATE: 02/02/2024
NARRATIVE
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Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Facility uses binder to sign in and out children . During the pickup binder provided to the parents to sign out the children .

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Inspection of required forms was made and documented on the LIC 857. Children's records were complete .

At 12:25 pm LPA`s reviewed six staff records. Based on six staff records review and interview with Facility Representative, four staff members were missing immunization records.(Measles, Pertussis, Influenza) , which posses potential risk to Health and Safety in children in care .

Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859.

Staff present had proof of the AB 1207 Mandated Reporter Training certificate on file.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providersdocumentation was reviewed.

Facility does not have any children that need medications .

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

LPA advised the licensee to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.


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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOT GAME SPORTS
FACILITY NUMBER: 197419969
VISIT DATE: 02/02/2024
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Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.



For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21-CCP).
LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

Per Facility Representative they don't have any information regarding the lead .

At 12:53 pm LPA`s observed that facility did not complete testing prior to their deadline , which poses potential risk to the Health and Safety to children's in care.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.


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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC809 (FAS) - (06/04)
Page: 4 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOT GAME SPORTS
FACILITY NUMBER: 197419969
VISIT DATE: 02/02/2024
NARRATIVE
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Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D(Deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

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 conducted and report was reviewed with facility representative Jensett Tubbs and Mahrischra Medina .

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 02/02/2024 02:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: GOT GAME SPORTS
FACILITY NUMBER: 197419969

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations interview and record review, the licensee did not comply with the section cited above , facility did not complete lead testing , which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2024
Plan of Correction
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Per facility representative, they will follow up to schedule an appointment for the lead testing and will email appointment confirmation to the LPA by POC date .
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations , the licensee did not comply with the section cited above, classroom #27 red and blue carpet had stains and dust, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/09/2024
Plan of Correction
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Per facility representative, old red/blue carpet will be removed and replaced with new one and a picture will be emailed to LPA by POC date .
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 03/22/2024 11:26 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/20/2024 02:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: GOT GAME SPORTS
FACILITY NUMBER: 197419969

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(c)
Reporting Requirements
(c) The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations , interview and records review the licensee did not comply with the section cited above and used room #27 without departments permission and fire clearance ,which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2024
Plan of Correction
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Per licensee, application and updated sketch for room #27 will be mailed to the office and emailed to LPA by POC date .
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
LIC809 (FAS) - (06/04)
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