198007926-6-15-2023-33-CC-VMGA-CSTSB4-20230615134318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198007926
Report Date: 06/15/2023
Date Signed: 06/15/2023 01:43:28 PM

Document Has Been Signed on 06/15/2023 01:43 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:	GOOD SHEPHERD CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	198007926
ADMINISTRATOR:	AYDEE QUINTANA		FACILITY TYPE:	850
ADDRESS:	6338 N. FIGUEROA STREET		TELEPHONE:	(323) 255-2786
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90042
CAPACITY:	36	CENSUS: 19	DATE:	06/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Director Aydee Quintana		TIME COMPLETED:	02:00 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	Licensing Program Analyst (LPA) Veronica MartinezGarza and Licensing Program Manager (LPM) Ana Chico conducted an unannounced 1-year required inspection at the above facility on 06/15/23 at 08:50 a.m. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Director Aydee Quintana who guided LPA on a tour of the facility. This is a preschool age program licensed for 36 children which operates Monday – Friday from 07:00 a.m. – 06:00 p.m. Per Director, there are 27 children enrolled. The purpose of this inspection is also to inspect and measure the 1st Grade classroom as facility is requesting a room change. The Buddy Bears classroom will now be operating in the classroom across the way currently identified as the 1st Grade classroom which was previously part of the private school elementary. Licensee is not requesting a change in the current capacity. A fire clearance was approved for the proposed classroom change. LPA and LPM measured the room which will be identified as the Buddy Bears. Measurements taken found that there is sufficient indoor space to accommodate the current capacity. All areas identified on the Facility Sketch were inspected. The following staff was present during this inspection: Busy Bees: staff #2 (S2) with 10 children, Buddy Bears: staff #3 with 9 children, and Koala had no children or staff present. Per Director, the Koala room is not being used. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded on the attached LIC859. 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. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All floors are safe and clean. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Drinking water was readily available indoors. Page 1 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD SHEPHERD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198007926
	VISIT DATE: 06/15/2023

NARRATIVE

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LPA observed stacks of cots stored as napping equipment in the office. All toilets and hand washing facilities are safe, sanitary and are operating properly. At this time, the "office" is used as an isolation area. A cot is available for an ill child to rest on. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. 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. The facility was observed to be free of flies, other insects, and rodents.

LPA observed all required forms/publications to be posted in the Busy Bees classroom. Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Snacks were reviewed for availability, quantity, and appropriateness to children in care. The facility provides AM and PM snack, and children bring their own lunch. Parents also have an option to purchase lunch through an outside vendor. Facility does not use the kitchen. All food prep and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination.

First Aid supplies are available and complete. Facility has a functioning carbon monoxide detector that meets statutory requirements. There are (3) fire extinguishers indicating fully charged and were last serviced on 08/17/2022, as indicated on the service tag. Director states there are no weapons, firearms, or bodies of water on the premises.

At 9:10 a.m. the outdoor play equipment was observed to be in good condition, free of sharp, lose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment have a cushioning material to absorb a fall. LPA observed drinking water is readily available outdoors. There is adequate shade in the play yard. Preschool children have their own private back yard completely fenced.

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. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. LPA observed child #3 (C3) is missing LIC 701 Physician's Report.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD SHEPHERD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198007926
	VISIT DATE: 06/15/2023

NARRATIVE

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Staff Records were reviewed to ensure that appropriate documentation of education credits is on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. Staff did have a current Mandated Reporter Training as required. LPA observed S2 and S3 are missing proof of Immunizations MMR and Tdap.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Director.

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.

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

Licensee 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

LPA advised the Director how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD SHEPHERD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198007926
	VISIT DATE: 06/15/2023

NARRATIVE

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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.

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.

Exit interview conducted and report was reviewed with Director Aydee Quintana and appeal rights were provided.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 06/15/2023 01:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD SHEPHERD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198007926
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/15/2023

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
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in Staff #2 is missing proof of MMR and Staff #3 is missing proof of MMR and Tdap which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2023
	Plan of Correction
1 2 3 4	Per Director, she will submit proof of MMR and Tdap for Staff #3 to LPA by POC due date. Per Director, Staff #2 last day is today 06/15/23 but Director understands that staff should have proof of Immunizations on file prior to employment.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 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: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC809 (FAS) - (06/04)

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