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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493723
Report Date: 09/15/2021
Date Signed: 09/15/2021 01:49:53 PM

Document Has Been Signed on 09/15/2021 01:49 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:EL SEGUNDO CO-OP NURSERY SCHOOL GROUPFACILITY NUMBER:
197493723
ADMINISTRATOR:CHRISTINE LUBSFACILITY TYPE:
850
ADDRESS:300 E PINE AVETELEPHONE:
(310) 524-2892
CITY:EL SEGUNDOSTATE: CAZIP CODE:
90245
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Christine Lubs, DirectorTIME COMPLETED:
02:00 PM
NARRATIVE
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On 9/15/2021 at 10:00 am Licensing Program Analyst (LPA) Deborah Lowe, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director, Christine Lubs, and toured the facility indoors and outdoors. Days and hours of operation are Tuesday – Thursday 9:00 am – 12:00 pm. Two parent volunteers were in attendance during visit.
LPA Lowe did not observe a swimming pool or other bodies of water on the premises. Director verified there is no swimming pool or other bodies of water located at this park. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items were observed to be inaccessible located on high shelves or in director’s office outside of classrooms. All poisons are kept in a locked storage area. No poisons were observed during the inspection.
Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Facility is located at a park and the playground is a shared space with the public. Playground equipment was observed to be in
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 09/15/2021 01:49 PM - It Cannot Be Edited


Created By: Deborah Lowe On 09/15/2021 at 12:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: EL SEGUNDO CO-OP NURSERY SCHOOL GROUP
FACILITY NUMBER: 197493723

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2021
Section Cited
HSC
1596.866(C)(i)

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1596.866(C)(i) A preventive health practices course or courses that include instruction in the recognition, management, and prevention of infectious diseases, including immunizations, prevention of childhood injuries,...
This requirement has not been met by evidence by
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Director will enroll in preventive health & safety practices. Director will show proof via email 10/15/2021.
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Based on a file review of the Director. Director does not have proof of course in preventive heatlh practices
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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:Karren Starks
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2021


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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: EL SEGUNDO CO-OP NURSERY SCHOOL GROUP
FACILITY NUMBER: 197493723
VISIT DATE: 09/15/2021
NARRATIVE
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safe condition, free of sharp, loose or pointed parts. Playground area was observed to be closed off by a gate located just outside the classroom building. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. LPA observed the 2 restrooms to have 2 toilets and 1 in each with an additional sink in the classroom. Floors in the facility are clean and safe. LPA did not observe a kitchen area, children bring their own food from home. LPA Lowe advised all food shall be protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors, children bring water bottles from home. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility was observed to have a functioning carbon monoxide detectors that meet statutory requirements. LPA was able to hear the test of the carbon monoxide detector. LPA advised 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. Director was observed to have criminal record clearance. Parents volunteer once a week for 3 hours. LPA advised upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: EL SEGUNDO CO-OP NURSERY SCHOOL GROUP
FACILITY NUMBER: 197493723
VISIT DATE: 09/15/2021
NARRATIVE
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considers granting or denying an exemption. LPA observed 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 offsite 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. The person who signs the child in/out of the facility was observed to have used their full legal signature and record the time of day. All children were observed to be under supervision, including visual supervision, of a Director at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of 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 and medical assessment. LPA reviewed Director’s file and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Director file missing Preventative Health & Safety.
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
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: EL SEGUNDO CO-OP NURSERY SCHOOL GROUP
FACILITY NUMBER: 197493723
VISIT DATE: 09/15/2021
NARRATIVE
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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, the following deficiency is being cited: 1596.866(C)(i) (see next page, 809 D) Licensee was provided a copy of their appeal rights. Technical Advisory was provided regarding H&S 1596.7995(a)(1)

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.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
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