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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004408
Report Date: 03/21/2022
Date Signed: 03/21/2022 02:38:49 PM


Document Has Been Signed on 03/21/2022 02:38 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:ST. MATTHIAS PRE-KFACILITY NUMBER:
198004408
ADMINISTRATOR:RODRIGUEZ, ALEJANDRAFACILITY TYPE:
850
ADDRESS:7130 CEDAR STREETTELEPHONE:
(323) 588-7253
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:19CENSUS: 14DATE:
03/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Alejandra RodriguezTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced inspection. At 9:25 AM, LPA met with Alejandra Rodriguez, Director who guided analyst on tour of facility. This is a preschool program which consists of 1 portable classroom. This portable classroom is located towards the back of the school building in the corner of Florence Ave and Cedar St. Facility operation hours are from Monday to Friday from 8:00 AM to 3:00 PM. Children are released at 12:00 PM every Friday.

All areas identified on the Facility Sketch were inspected. The following staff was present during this inspection: preschool room: Staff #1 and #2 with 14 preschoolers. The following was observed during tour of facility:

Disinfectants, cleaning solutions and other items that may pose a danger to children, were observed to be inaccessible. LPA observed they are kept locked under the sink inside the classroom with a child safety lock. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. The portable room has a restroom with two sinks and two toilets. The playground used by the Preschool children is at the north end of the school building adjoining to the Pastor’s office.

At 10:30 AM LPA observed the food storage area is kept clean and free of litter, rubbish and rodents and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors. Children take their own bottles of water during outdoor activities. If the child does not bring a bottle of water one is provided. The facility was observed to be free of flies, other insects and rodents. Napping equipment and bedding were inspected for good condition, appropriate storage and cleanliness. Storage for children's belongings was inspected. Parents take linens home on Friday and returned on Monday.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022
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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Document Has Been Signed on 03/21/2022 02:38 PM - It Cannot Be Edited

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: ST. MATTHIAS PRE-K
FACILITY NUMBER: 198004408

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the director did not comply with the section cited above in 1 out of 14 children in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2022
Plan of Correction
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Director stated that a new battery was ordered and has not been delivered. Director will go purchase new batteries today. Going forward she will conduct testing and create a log. Director will provide proof via email to LPA by POC due date.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, staff #2 is missing proof of MMR. The director did not comply with the section cited above in 1 out of 2 persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/01/2022
Plan of Correction
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Director's plan of correction is to follow records to be maintained at the facility form LIC 311A to ensure this does not happen again. Director will provide proof via email to LPA by POC due date.

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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. MATTHIAS PRE-K
FACILITY NUMBER: 198004408
VISIT DATE: 03/21/2022
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Teacher child ratios were observed, and staff names recorded. Sign in and out sheets were reviewed.

Staff and Children’s Records were reviewed for completeness; Inspection of required forms was made.

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. There is adequate shade in the play yard.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed.

In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

Disaster drill log was available, last drill was conducted on 2/02/2022.

Menus for the past 30 days are available upon request. The food is catered by an outside vendor and the food is delivered to the classrooms at the designated time in an individualized plate for the children. Snacks are not provided by the school.

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.htm
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. MATTHIAS PRE-K
FACILITY NUMBER: 198004408
VISIT DATE: 03/21/2022
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The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

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. 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.

Director, Alejandra Rodriguez 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.

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 Director, Alejandra Rodriguez.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
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