197494608-11-25-2020-30-CC-JCHR-BVPNC8-20201125092020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494608
Report Date: 10/30/2020
Date Signed: 11/25/2020 09:20:34 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:	OUR LADY OF MALIBU CHURCH AND SCHOOL		FACILITY NUMBER:	197494608
ADMINISTRATOR:	REV MATHEW MURPHY		FACILITY TYPE:	850
ADDRESS:	3625 S WINTER CANYON RD		TELEPHONE:	(310) 456-8071
CITY:	MALIBU	STATE: CA	ZIP CODE:	90265
CAPACITY:	30	CENSUS: 0	DATE:	10/30/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:03 PM
MET WITH:	Micheal Smith		TIME COMPLETED:	03:15 PM

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On 11/30/2020 at 1:30 P.M. Licensing Program Analyst (LPA) Chandler made an announced visit to Our Lady of Malibu school/church for the purpose of conducting a pre-licensing inspection. LPA met with Michael Smith (Principle) who provided a tour of the facility. The applicant is requesting a preschool license for a capacity of 30. Approved fire clearance conducted by Captain Aaron Marks. The preschool operations will be conducted in a separate bungalow (formerly the kindergarten class) on the upper level of the school.

The following was observed of the:

INDOOR ACTIVITY SPACE

Fire extinguishers were 2AB10C or larger.
Carbon monoxide detector was observed inside the class room

First aid kit was located inside the class room with the required essentials: scissors, bandages, tweezers, and thermometer

Age appropriate toys and equipment were observed in good repair

During the pandemic children will bring there personal water

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

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: OUR LADY OF MALIBU CHURCH AND SCHOOL	FACILITY NUMBER: 197494608
	VISIT DATE: 10/30/2020

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Heating and Cooling was provided by through central system, windows were in good repair free of chipping paint, dirt, insects or debris

Adequate lighting was observed

The classroom was clean, in good repair

Storage for children’s belongings were observed

Trash cans used for solid waste were observed with tight fitting lids

No Fireplaces or open face heaters were observed

Disinfectants and cleaning solution and other toxins or poisons were made inaccessible

A room in the school's office will be used for isolation of ill children and the staff restroom located next to the office will be used for ill children

The classroom are equipped with working telephones

Parents/Authorized adult will sign in using their original signatures

Director shall create a parent board with the required posting, the board shall be placed in a common area for parents and visitors view.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

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: OUR LADY OF MALIBU CHURCH AND SCHOOL	FACILITY NUMBER: 197494608
	VISIT DATE: 10/30/2020

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Children shall use mats for napping, bedding shall stored individually and mats are to be wiped down after use.

Measurements for the indoor activity space was divided by 35 SQ. FT. per child = 771.07 for a total of 22 children

FOOD SERVICE:

Lunches and snacks can be purchased, the school has a private vendor who provides hot meal to the school No family style meals shall be served.

The school has a full kitchen for prepping and heating meals. LPA did not observe any contaminated foods in this area.

Weekly menus were posted for review. Applicant shall make preparation for alternate meals for children with allergies

Center shall devise an Incidental Medical Service plan and provide to parents of children with allergies (epi-pen), asthmatic (inhalers), and children needing Gastronomy (G-tube) feeding

Toxins and poisons were made inaccessible to children

Open foods were properly labeled and stored

The kitchen was clean in goo condition

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

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: OUR LADY OF MALIBU CHURCH AND SCHOOL	FACILITY NUMBER: 197494608
	VISIT DATE: 10/30/2020

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RESTROOMS

THERE WERE:

2 toilets 1 toilet per 15 children for a total of 30 children

2 sinks = 1 sink per 15 children for a total of 30 children

The restrooms were clean and sanitized with the necessary toiletries, sinks and toilets were operable and in good repair. Faucets delivered hot and cold water. Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

Toilets and sinks were standard sizes, applicant shall provide stable based stools to accommodate children's access to the toilet and sink if needed.

CAPACITY BASED ON SINKS AND TOILETS = 30

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

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: OUR LADY OF MALIBU CHURCH AND SCHOOL	FACILITY NUMBER: 197494608
	VISIT DATE: 10/30/2020

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OUTDOOR ACTIVITY SPACE

Age appropriate toys and equipment were observed on in the outdoor activity space in good repair.

The top play yard was partially gated with a four inch gate. The applicant shall add a gate to completely enclosed the play yard. The lower asphalt play yard was included in the measurements.

Resilient cushioning found in good repair under all climbing apparatus. The manufacturers recommendation posted stated that the structure was designed for ages 5 - 12 years.

Water fountains was available for outdoor water source, during the pandemic parents will provide water

Awnings in the lunch area provided shading

Benches for resting were available for children’s use

No hazardous equipment was observed during today’s visit

Measurements for the outdoor activity space= 3973.43 for a capacity of 52 children

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: OUR LADY OF MALIBU CHURCH AND SCHOOL	FACILITY NUMBER: 197494608
	VISIT DATE: 10/30/2020

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Based on todays inspection the recommended capacity based on the indoor measurements shall be 22

Due to Covid 19 the report was recorded the date of LPAs signature.

A copy of this report will be electronically mailed to the applicant/director for review and signature. A read receipt shall confirm as receipt of the electronically delivered report.

Applicant/Licensee shall print and sign the report and mail it with the original signature to the assigned l licensing office.

If there are any questions or concerns, please contact the department at (424) 301-3077

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

LIC809 (FAS) - (06/04)

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