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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004790
Report Date: 05/12/2022
Date Signed: 05/12/2022 02:02:04 PM


Document Has Been Signed on 05/12/2022 02:02 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. JOHN OF GOD PRE-KFACILITY NUMBER:
198004790
ADMINISTRATOR:TRACIE GUTIERREZFACILITY TYPE:
850
ADDRESS:13817 PIONEER BLVD.TELEPHONE:
(562) 863-5721
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:20CENSUS: 11DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director Kristen Muniz TIME COMPLETED:
02:15 PM
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On 5/12/22 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection. LPA met with Director Kristen Muniz who guided analyst on a tour of the facility. This is a preschool program which consists of one classroom. Facility operates from Monday through Thursday 7:30AM to 2:30PM and Fridays 7:30AM to 11:45AM. There were 11 children present with 2 staff when LPA arrived.

All areas identified on the facility sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Children nap on cots in each classroom on Mondays through Thursdays-On Friday there is no nap time. Children bring their own bedding and take it home each week to maintain clean. The isolation area is located in the front office. Program has a waiver for use of the restrooms. Preschool program shares a restroom with the elementary school on site. Teacher supervision is provided when Preschool children use the restroom. There are 8 toilets and 8 sinks available. General sanitation was observed. Availability of indoor drinking water was observed in classrooms via water bottles. Per Director, Teachers assist children with the drinking water if they need to re-fill their water bottles. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Per Director, there are no poisons stored at the facility and medications are stored in a cabinet in the classroom, inaccessible to children in care. A combination carbon monoxide/ smoke detector were available in the classroom and they are operable. The outdoor playground area was evaluated. There is also a waiver for the outdoor play area. Outdoor play area is shared with the elementary school on site. Children are supervised while using the outdoor play area. Per Director, children do not use the large slide on the playground. LPA observed other equipment is in a safe condition, free of sharp, loose or pointed parts. All areas around or under high climbing equipment and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed via water bottles.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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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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. JOHN OF GOD PRE-K
FACILITY NUMBER: 198004790
VISIT DATE: 05/12/2022
NARRATIVE
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Per Director there are no firearms stored on the premises. There are no pools or bodies of water at the facility. There is a 2A10BC fire extinguisher available in the classroom which indicates full and was last serviced in 8/2020.
Director 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.
Children’s Records were reviewed for completeness. (The name, address, and telephone number of child’s authorized representative and medical assessment are on file). Two out of 10 files reviewed did not have a medical/physical assessment on file.
LPA also reviewed staff records.Two out of three Staff present did not have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff 1 did not have proof of immunization of Measles, Staff 2 did not have proof of current TB clearance dated within one year or within 7 days of hire. Staff 3 did not have a complete file. All staff present had current training on Pediatric CPR/ First Aid.
Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Disaster drill log was available, last drills were conducted on 3/16/22.
Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Menus are posted online one week in advance for children's authorized representatives. Menus for the past 30 days are available upon request. The facility utilizes a vendor for lunch (some children bring lunch from home) and two snacks.
First Aid supplies are available in the classroom.
Incidental Medical Services (IMS) policy was discussed. LPA provided PIN 22-02-CCP 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: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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. JOHN OF GOD PRE-K
FACILITY NUMBER: 198004790
VISIT DATE: 05/12/2022
NARRATIVE
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LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
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/tion-process. A current email address was collected during today's visit.
The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and Appeal Rights and report were reviewed with the Director Kristen Muniz .
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/12/2022 02:02 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. JOHN OF GOD PRE-K
FACILITY NUMBER: 198004790

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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, the licensee did not comply with the section cited above in two out of three staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Per Director, Proof of immunization of Measles for staff 1 and Proof of immunization of measles, pertussis and flu will be submitted for staff 3 by POC due date
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of three staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Per Director mandated reporter certificate will be submitted by 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: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6


Document Has Been Signed on 05/12/2022 02:02 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. JOHN OF GOD PRE-K
FACILITY NUMBER: 198004790

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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Based on record review, the licensee did not comply with the section cited above in two out of thhree teachers which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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2
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Per Director proof of LIC 503 for Staff 3 and Tb clearance for Staff 2 will be submitted by due date
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in one of three which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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Per DIrector, proof of complete file for staff 3 will be submitted by 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: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6


Document Has Been Signed on 05/12/2022 02:02 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. JOHN OF GOD PRE-K
FACILITY NUMBER: 198004790

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record, the licensee did not comply with the section cited above in two out of ten children's file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/13/2022
Plan of Correction
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2
3
4
Per DIrector LIC 701 will be submitted by due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4

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: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6