197494267-8-12-2019-30-CC-SMAZ-BEYNGM-20190812102721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494267
Report Date: 08/12/2019
Date Signed: 08/12/2019 10:27:37 AM

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:	WEBSTER SEASIDE PRESCHOOL		FACILITY NUMBER:	197494267
ADMINISTRATOR:	DR SUSAN SAMARGE-POWELL		FACILITY TYPE:	850
ADDRESS:	3602 WINTER CANYON		TELEPHONE:	(310) 456-6494
CITY:	MALIBU	STATE: CA	ZIP CODE:	90265
CAPACITY:	24	CENSUS: 0	DATE:	08/12/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Dr. Susan Samarge-Powell, Applicant		TIME COMPLETED:	10:45 AM

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 08/12/2019 at 08:30 am, Licensing Program Analyst (LPA) Sabrina Martinez conducted an announced inspection for the purpose of a Prelicensing visit. LPA met with applicant Dr. Susan Samarge-Powell, Executive Director and Janice Onami, Malibu Unified School District Consultant. The Santa Monica-Malibu Unified School District is requesting a capacity of 24 children. The facility has a granted fire clearance from the Los Angeles County Fire Department. The facility will occupy 1 classroom (Classroom 11) on the site of Webster Elementary School (SMMUSD). Applicant will have exclusive use of the classrooms during hours of operation. Hours of Operation/Quiet Time/Equipment The program will be open from Monday through Friday 7:00 am to 6:00pm. Children will be offered quiet time daily. There are sufficient cots for children. Applicant is reminded that children utilizing the cots must have some type of barrier between them and the cots such sheets or blankets may be used. Sheet and blankets must be stored separately when not in use. Children will nap in their designated classroom. Access to the Facility Parents will park in the parking space in front of the facility. Parents will enter through the side gate of the property to get to the entrance of the building. Sign in and sign out Applicant and the Director is to ensure that the person who signs the child in/out shall use his/her full legal signature and shall record the time of day. The main sign in will be inside the classroom.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WEBSTER SEASIDE PRESCHOOL	FACILITY NUMBER: 197494267
	VISIT DATE: 08/12/2019

NARRATIVE

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The following was discussed with the applicant: 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.html.

Required Postings/Licensee shall have posted in the Child Care Center at all times the following:

Facility license.
Personal Rights form (LIC 613A).
Menus.
Child passenger restraint system poster. (PUB 269).
Daily activity schedule.
Emergency Disaster Plan (LIC 610) and Earthquake Preparedness Checklist (LIC 9148).
Parent’s Rights Poster (PUB 393).
Notice of Site Visit (LIC 9213).
Any licensing report documenting a type”A” citation must be posted for 30 days.
Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type A deficiency must be posted for 30 days.

Employee/Volunteer Files shall also be maintained and shall contain the following

Health Screening Report - Facility Personnel (LIC 503) and TB Clearance.
Proof of Immunizations
Mandated Reporter Training Certificate of Completion
TB Clearance and "Good Health" statement from volunteers.
Personnel Record (LIC 501) or application/resume.
Evaluation of Director Qualifications (LIC 9096).
Evaluation of Teacher Qualifications (LIC 9095).

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WEBSTER SEASIDE PRESCHOOL	FACILITY NUMBER: 197494267
	VISIT DATE: 08/12/2019

NARRATIVE

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Criminal Record Statement (LIC 508) for staff subject to fingerprint requirements.
Fingerprint clearances - Proof of clearance (Criminal Record, FBI and Child Abuse).
Appropriate driver's license for person(s) transporting children.

Licensee shall maintain Administrative Records which shall have the following:

Administrative Records
Written inspection procedures for accepting children on a daily basis.
Sign-in/sign-out sheets kept for current 30 days, or approved waiver to use electronic pin system.
Admission policies, including admission criteria, ages of children who will be accepted; medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any.
Designation of Facility Responsibility (LIC 308).
Personnel Report (LIC 500) showing current roster.
Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months. Documentation of drills shall be maintained for at least one year.Up-to-date list of qualified teacher substitutes.
Documentation of exceptions and waivers: Facility Waiver Request (LIC 956) and Exception/Exemption Request (LIC 971).
Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). and a Child Care Facility Roster (LIC 9040).

The applicant was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541.
Email Address: childcareadvocatesprogram@dss.ca.gov

An exit interview was conducted and a copy of this report was provided to Dr. Susan Samarge Powell, applicant.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WEBSTER SEASIDE PRESCHOOL	FACILITY NUMBER: 197494267
	VISIT DATE: 08/12/2019

NARRATIVE

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Indoor Activity Space

Based on the measurements obtained, the indoor space allows 24 children. LPA observed furniture and equipment to be in good condition, free of sharp, loose, or pointed parts. The children's rest rooms are located adjacent to the classroom. The restroom is shared with the Elementary school students and a waiver for shared use was submitted to the Department. The rest room contains two (2) toilets. LPA also observed (3) three sinks in the classroom. There is dispensable soap and paper towels in the bathrooms.

Overhead lighting provides the majority of the light in the classroom, but sunlight comes through doors and windows. Cubbies are available for children's belongings. The classroom has a drinking fountain and children will be bringing their own water bottles as well.

Outdoor Activity Space

Based on the measurements obtained, the outdoor space allows 24 children. Applicant has requested a waiver for the shared use of the outdoor play space. Applicant understands this waiver request is subject to approval.

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 slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. The playground is enclosed by a fence which is at least four feet high. There are two drinking fountains in the outdoor yard.

Medication/First Aid Kits

Medication if administered is to be properly labeled and stored in the original container. Applicant and Director were advised that children should be screened every morning for illness and unusual marks. First Aid supplies are stored in the classroom and in the general adult areas.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019

LIC809 (FAS) - (06/04)

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