<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001890
Report Date: 12/20/2019
Date Signed: 12/20/2019 05:33:08 PM

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:CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVINFACILITY NUMBER:
198001890
ADMINISTRATOR:PERAZA, JEANNEFACILITY TYPE:
840
ADDRESS:1925 S. BUDLONG AVE.TELEPHONE:
(323) 731-0703
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY:50CENSUS: 9DATE:
12/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Robert Page_DirectorTIME COMPLETED:
05:45 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
On December 20, 2019 at 3pm Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced annual random inspection at the facility listed above. LPA met with Director Robert Page for a guided tour of the facility. There were nine children, two teachers as well as the Director present upon arrival. At 3:30pm an additional Teachers Aide Jefte Huertas arrived to the facility. The program operates on the west grounds of Salvin Elementary School in the multi-purpose room.

Program operates 2:00 - 5:00 Monday-Friday according to LAUSD school calendar.

LPA toured the facility according to the sketch on file. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service,(Director cell phone; 213-248-9225) lighting and ventilation were observed. Required postings including Daily Activities, License, Menus, and Parents Rights were observed posted opposite the office. LPA observed Disaster drill log posted with last drill dated 12/3/19. First Aid supplies were observed in a main office file cabinet.

Sleeping equipment including mats were observed in a separate storage room. Availability of indoor drinking water was observed in the classroom.

LPA observed the isolation restroom located on the LAUSD campus outdoor play yard. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms.

Kitchen, refrigerator and pantry were observed in compliance. Per the Director, snacks are provided. Food and snacks menus were reviewed for availability and appropriateness to children in care. Children are provided up to two snacks per day.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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 4
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: CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVIN
FACILITY NUMBER: 198001890
VISIT DATE: 12/20/2019
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
Children and staff records were reviewed and observed. Per the Director one children's file and one Staff file were not available. The Center Director has current pediatric CPR/1st aid training to expire on 03/07/2020.

The outdoor toys and equipment were inspected for safety, good repair and age appropriateness. Required shade and fencing were found in compliance. LPA observed outdoor play yard with two functional water fountains.

Teacher child ratios were observed in compliance. All children were adequately supervised. LPA advised Director to review www.ccld.ca.gov for department updates and changes.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

See attached deficiencies page (LIC 809D) for citations in accordance with Title 22 California Code of Regulations and/or the Health and Safety Code. Deficiencies cited must be cleared to protect the children’s health & safety.



Exit interview conducted with Director. A copy of this report and appeal rights were provided.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVIN
FACILITY NUMBER: 198001890
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2019
Section Cited

1
2
3
4
5
6
7
Facility Roster
Current roster of children provided care in facility required. Each child day care facility shall maintain a current roster of children who are provided care in the facility. This roster shall be available to the licensing agency upon request.
8
9
10
11
12
13
14
This requirement has not been met as evidenced by: Based on LPAs record review this requirement has not been met as evidenced by no Facility Roster was available for review. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
12/30/2019
Section Cited

1
2
3
4
5
6
7
Personnel Record
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement has not been met as evidenced by LPAs observation of no file
8
9
10
11
12
13
14
available for Staff #4.

This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CAROUSEL'S AFTER SCHOOL PROGRAM AT SALVIN
FACILITY NUMBER: 198001890
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2019
Section Cited

1
2
3
4
5
6
7
Children’s Records
This requirement was not met as evidenced by C8 did not have a file available at the facility.

This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4