197494434-3-16-2023-30-CC-LPHS-CPYRUE-20230316131948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494434
Report Date: 03/16/2023
Date Signed: 03/16/2023 01:19:56 PM

Document Has Been Signed on 03/16/2023 01:19 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:	BLOOM PRESCHOOL		FACILITY NUMBER:	197494434
ADMINISTRATOR:	PIPER, KAWAILANI		FACILITY TYPE:	850
ADDRESS:	13560 HAWTHORNE BLVD		TELEPHONE:	(310) 908-4551
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	24	CENSUS: 24	DATE:	03/16/2023
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	KAWAILANI PIPER, DIRECTOR		TIME COMPLETED:	01:30 PM

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On 3/16/2023, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on COVID-19 Positive Case Outbreak. LPA met with Director, Kawailani Piper and explained the reason for visit, toured the facility and took a census. Upon arrival, there were 24 children and 4 staff present today at the facility. LPA toured 2 classrooms, restrooms and outdoor play area.

LPA observed the sign in area displaying a COVID-19 Exposure Notice from DPH with exposure dates of 2/28, 3/1, 3/2, 3/3, 3/6 and 3/7. All staff and children have tested negative as 3/16/2023.

All the restrooms were functioning properly, fully stocked with soap, tissue and paper towels. Each child have a cubby for their personal belongings. The children bring their personal water bottles and the facility provides water as needed.

During the visit LPA and Director discussed the following best practices:

Arrival Procedures - Continue to do overall wellness checks on children.

Face Mask - Some parents are continuing to have their children wear face mask while indoors.

Cleaning and Disinfecting - Janitor disinfect high touched surface areas daily.

Supplies - The facility has a supply of mask, gloves and hand sanitizer. Director will reach out to Resource and Referral agency for additional supplies.

Isolation area - The facility has a designated isolation area.

809-C

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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: BLOOM PRESCHOOL	FACILITY NUMBER: 197494434
	VISIT DATE: 03/16/2023

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Reporting Requirements – LPA explained and reminded Director to report all COVID-19 positives to Department of Public Health. In addition, report all positives cases 2 or more CCLD. When reporting Unusual Incidents, call CCLD within 24 hours and submit Unusual Incident Report within 7 days to ESROSupportStaff@dss.ca.gov.

LPA provided the number to DPH 877-777-5799 for Guidance.

No deficiencies are being cited in accordance to Title22 of the California Code of Regulations and/or Health & Safety Codes.

An exit interview was conducted, a copy of this report and notice of site visit were provided to Director.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC809 (FAS) - (06/04)

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