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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007161
Report Date: 04/12/2022
Date Signed: 04/12/2022 12:27:33 PM


Document Has Been Signed on 04/12/2022 12:27 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:BIRNEY ELEMENTARY SCHOOLFACILITY NUMBER:
198007161
ADMINISTRATOR:ANITA GARCIAFACILITY TYPE:
850
ADDRESS:8501 ORANGE AVENUETELEPHONE:
(562) 801-0647
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:22CENSUS: 10DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Blanca Zazueta- Substitute Lead Teacher TIME COMPLETED:
12:40 PM
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At 8:45 AM Licensing Program Analysts (LPA’s) Roxana Lopez and David Kurdoglyan conducted an unannounced required inspection. A risk assessment was conducted prior to entering the facility appropriate PPE was used. LPA met with Lead Substitute Teacher, Blanca Zazueta, who guided the LPA'a on a tour of the facility. This is a preschool age program licensed for 22 children which operates Monday – Friday. The facility consists of only one classroom with an AM program from 9:00 AM- 12:00 PM and PM program from 1:00 PM – 4:00 PM. Per Lead Teacher there are 12 children enrolled in each program. Director, Roberta Gonzalez arrived at 10:00 AM with files to review.

All areas identified on the Facility Sketch were inspected. Facility is located in a bungalow on the Birney Elementary School Campus. The following staff was present during this inspection: Staff #1 and Staff #2 with 10 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 library area in the classroom is used as an isolation area. Per Lead Substitute Blanca Zazueta if needed children are taken to the elementary main office.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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: BIRNEY ELEMENTARY SCHOOL
FACILITY NUMBER: 198007161
VISIT DATE: 04/12/2022
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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.

Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides one snack per program. Per Lead Substitue Teacher snack is picked up every morning from the cafeteria and stored in the classroom refrigerator and or cabinets. 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 in form of water bottles brought from home and a water fountain in the classroom to refill. 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 detectors in the facility and were found to be operable. The last Disaster and Fire Drill was conducted on 3/28/2022.

Facility has a waiver on file to use the kindergarten playground for outdoor play. LPA’s observed schedule for outdoor play. 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. Children bring their water bottles outside and there is also a water fountain available for refills.

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: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
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: BIRNEY ELEMENTARY SCHOOL
FACILITY NUMBER: 198007161
VISIT DATE: 04/12/2022
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Staff Records were reviewed to ensure that a health screening report is on file. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. All staff have received an active criminal record clearance as a condition of their employment with the El Rancho Unified School District.

LPA issued the Children’s Record Review (LIC 857) and the Staff’s Record Review (LIC 859) to the Director during this inspection.

SB792 (Immunization Requirements for Staff and Employees) was discussed with Lead Substitute Teacher, LPA observed that all required Immunizations on file.

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. All staff present had AB1207 on file.

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 - 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 consulted with Lead Teacher regarding COVID-19 health and safety guidelines on this date, LPA observed COVID- 19 postings posted in the day care on this date.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
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: BIRNEY ELEMENTARY SCHOOL
FACILITY NUMBER: 198007161
VISIT DATE: 04/12/2022
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

Lead Teacher 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
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.

Exit interview conducted and report was reviewed with Lead Substitute Teacher Blanca Zazueta

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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