197494017-10-6-2021-54-CC-AMOY-C7JKNW-20211006080350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494017
Report Date: 10/05/2021
Date Signed: 10/06/2021 08:04:24 AM

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:	MARTIN LUTHER KING JR LEARNING CENTER - INFANT		FACILITY NUMBER:	197494017
ADMINISTRATOR:	CAMARENA,E & LUNA,R		FACILITY TYPE:	830
ADDRESS:	12029 S WILMINGTON AVE		TELEPHONE:	(424) 338-1980
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	39	CENSUS: 26	DATE:	10/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ana Martinez, Assistant Director		TIME COMPLETED:	03:30 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

Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced annual inspection. LPA met with Ana Martinez, Assistant Director, and explained the purpose of the inspection, explain that the facility will be inspected using the Inspection Tool, and explain that the LPA and licensee will jointly address any deficiencies of licensing statutes, regulations, and interim licensing standards identified during the inspection. LPA provided licensee with and explained the Entrance Checklist, LIC 125, and requested that the items on the sheet be made available for inspection. The Assistant Director guided analyst on a tour of the facility. This is an infant program which consists of three (3) classrooms: RM 1 (Infants ages 6 weeks to 12 months) ; RM 2 (Infants ages 12 months to 24 months) and RM 3 (Infants ages 12 months to 24 months).

Upon arrival LPA observed 7 infants and 2 staff in Rm1, 11 infants and 3 staff in RM 2, and 8 infants and 2 staff in RM 3. Facility operation hours are Monday to Friday from 6:30 AM to 6:00 PM. Infant center is in a separate location from preschool component #197494018.

There is a designated infant napping area in RM 1. Children have their own cubby to store their belongings. LPA observed cribs use for infants. Facility enough cribs to occupy one infant at a time. Cribs were observed to be free of loose articles and objects including blankets and pillows.

Infant Rooms are equipped with built in changing stations that have built in sinks that are in arms reach. Underneath the built in changing stations there is a pail for the soiled diapers.

LPA observed furniture and equipment to be in good condition, free of sharp, loose, or pointed parts. All areas identified on this report were inspected. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. All children were observed to be under visual supervision of a teacher at all times.

Page 1 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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 5

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: MARTIN LUTHER KING JR LEARNING CENTER - INFANT	FACILITY NUMBER: 197494017
	VISIT DATE: 10/05/2021

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
26
27
28
29
30
31
32

Sign in and out sheets were reviewed. The Assistant Director was reminded to ensure that person who signs the child in and out uses their full legal signature and records the time of the day. The children present were signed in. Menus were observed in each classroom and posted at least one week in advance. Indoor and outdoor drinking water is readily available via a water dispenser and cups. Children also have their own Sippy cup.
Furniture and equipment was inspected for age appropriateness and good repair. Toys were observed to be safe, and do not have sharp points, edges, splinters and are not made of small parts that can pose a choking hazard. LPA did not observe any baby walkers or any items that fall into that category present in the facility. All materials and surfaces accessible to children are toxic free. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean.

LPA informed Director of the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants up to 12 months, 15 minute sleep check and provided PIN 20-24-CCP. Per Assistant Director, when children are almost two years old they transition to a cot. Linens are changed daily or more frequently, as needed by staff. LPA observe infant sleep log for all 7 infants 12 months and younger. LPA observed 2 napping infants sleeping on their backs with no loose items.

Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. LPA observed that infant changing tables have a padded surface covered with washable vinyl or plastic.

Telephone service, heating, lighting and ventilation were evaluated and are in operating condition. Per Assistant Director, the isolation area is located in a room next to the office where child will be supervised until they are picked up by parents. Parents are contacted immediately when children are determined to be ill.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were observed to be inaccessible. According to the Assistant Director, medication is only administered to a child when accompanied by a doctor's note and is stored in the classroom inaccessible to children with the child’s name and date. Per Assistant Director there are no children with medication at this time.

Page 2 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: MARTIN LUTHER KING JR LEARNING CENTER - INFANT	FACILITY NUMBER: 197494017
	VISIT DATE: 10/05/2021

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
26
27
28
29
30
31
32

Director states that there are no poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock.
All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment, swings and slides have cushioning material to absorb a fall. The outdoor area has adequate shade. The Assistant Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. There is a water table with a cover that is emptied after use. Director states there are no weapons or firearms on the premises.

Staff records were reviewed. LPA observed Staff required units, Current Pediatric first aid and CPR, immunization's, Mandated Reporter training and health screening on file. Children’s Records were reviewed to ensure that Identification and Emergency, Needs and Services Plan, and LIC 9227- Infant Sleep Plan (0-12 months) are on file. During Staff and Child record review LPA observed that 3 of the 7 children did not have the LIC 9227 Infant Sleep Plan on file, this poses a potential risk to the health and safety of children in care. In Addition, Estefany Fonseca was not associated to the the above facility the LIC 9182 was in the file and the Assistant Director stated sent the documents to the Department via FAX to be associated. LPA will determine if a deficiency will be issued after an office file review.

LPA conducted COVID-19 Technical Assistance visit with licensee. LPA observed that licensee is still implementing COVID-19 precautions and procedures.

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

Page 3 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: MARTIN LUTHER KING JR LEARNING CENTER - INFANT	FACILITY NUMBER: 197494017
	VISIT DATE: 10/05/2021

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
26
27
28
29
30
31
32

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

The Assistant Director was reminded that all adults 18 and over living or working in the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed facility. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Assistant Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Assistant Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The following deficiencies are being cited in accordance to Title 22 Regulations (See LIC 809D).

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Assistant Director, Ana Martinez

Page 4 of 4 END OF REPORT

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: MARTIN LUTHER KING JR LEARNING CENTER - INFANT	FACILITY NUMBER: 197494017
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/05/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.2(b)(2)

Infant Needs and Services Plan

(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of the 7 infants did not have the LIC 9227 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/12/2021
	Plan of Correction
1 2 3 4	Per Assistant Director the LIC 9227 will be completed for the 3 infants and a copy will be sent the department via email by POC due date

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 5 of 5