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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003333
Report Date: 12/08/2022
Date Signed: 12/08/2022 02:50:58 PM


Document Has Been Signed on 12/08/2022 02:50 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:WASHINGTON ELEM. HEAD START-MADISON AVE.FACILITY NUMBER:
198003333
ADMINISTRATOR:MARIANA SANCHEZFACILITY TYPE:
850
ADDRESS:1400 W. MADISON AVE.TELEPHONE:
(323) 887-2177
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:42CENSUS: 14DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lead Teacher Gabriela Burgos TIME COMPLETED:
03:00 PM
NARRATIVE
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At 11:30 AM Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced required inspection. A risk assessment was conducted prior to entering the facility appropriate PPE was used. LPA met with Lead Teacher, Gabriela Burgos, who guided the LPA on a tour of the facility. At 12:00 pm Education Specialist Jackie Ellingson arrived and continued with the tour. This is a preschool age head start program licensed for 42 children which operates A full day program in H1 Monday – Friday 8:15 am to 2:50 pm and two half day programs, H2 8:15- 11:45 am and H3 12:15pm – 3:45 pm. Per Lead Teacher there 54 children enrolled.

All areas identified on the Facility Sketch were inspected. Facility is located in 2 classrooms on the Washington Elementary School Campus. The following staff was present during this inspection: H1: Staff #1, Staff #2 with 14 children and H3: Staff # 3 and Staff # 4 with 0 children. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license.

LPA observed the facility to be clean, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. Classroom was inspected to ensure that the floors have a surface that is safe and clean. All toilets and washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free.

At this time, the middle section that divides the classrooms is used as an isolation area.Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted. ----- pg 1 of 4------

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON ELEM. HEAD START-MADISON AVE.
FACILITY NUMBER: 198003333
VISIT DATE: 12/08/2022
NARRATIVE
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The facility provides breakfast, lunch and snack for the full day program, breakfast, lunch for am half day and lunch and supper for the pm half day. Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Per Lead Teacher meals are picked up daily by staff. Meals are stored in the refrigerator located in the kitchen area dividing both classrooms. All food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately.

There is drinking water available in the classroom via water dispenser. Water pitchers and dixie cups are taken outside for children to drink. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children.

LPA observed that there is smoke and carbon monoxide detector in the facility and were found to be operable. The last Disaster and Fire Drill was conducted on 11/12/2022.

LPA observed sleeping arrangements in form of cots- sheets are sent home every Friday to be washed.

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 high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON ELEM. HEAD START-MADISON AVE.
FACILITY NUMBER: 198003333
VISIT DATE: 12/08/2022
NARRATIVE
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 There is at least one person trained in CPR and Pediatric First Aid present during this inspection. All staff have received an active criminal record clearance as a condition of their employment with the Montebello Unified School District

LPA did not review staff files during the inspection due to the staff files being stored at the Montebello School District. LPA will review staff files at a later time and date. If files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

LPA issued a copy of the LIC 857 which documents the children’s records reviewed.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. AB1207 certificate was on file for all staff present.

LPA discussed the safe sleep regulations with licensee facility representative 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 facility representative 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual -
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WASHINGTON ELEM. HEAD START-MADISON AVE.
FACILITY NUMBER: 198003333
VISIT DATE: 12/08/2022
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Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

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

Facility representative was reminded that all adults 18 and over, 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 Child Care Center. 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.

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.m 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/process.

At this time, the facility is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Lead Teacher Gabriela Burgos.-- pg. 4 of 4 --
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4