198010922-3-21-2022-54-CC-AMOY-CCQSHH-20220321135335

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010922
Report Date: 03/21/2022
Date Signed: 03/21/2022 01:53:59 PM

Document Has Been Signed on 03/21/2022 01:53 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:	CUDAHY PRESCHOOL ACADEMY		FACILITY NUMBER:	198010922
ADMINISTRATOR:	ADOL VERGARA		FACILITY TYPE:	850
ADDRESS:	4912 CLARA ST		TELEPHONE:	(323) 771-8700
CITY:	CUDAHY	STATE: CA	ZIP CODE:	90201
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 37	CENSUS: 23	DATE:	03/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Adol Vergara, Diector		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) Alicia Mooberry conducted an unannounced required 1 year inspection to the above facility on 03/21/22. Upon arrival LPA met with Adol Vergara, Director, who provided a tour of the facility. LPA provided the LIC 125 Entrance Checklist upon arrival to help facilitate the inspection. This facility is located in the campus of a church building. This is a preschool program that has 3 classroom. Classroom C-2 is used for part-time AM session. Classrooms B-6 and B-7 are used for full day program. The facility operates from Monday through Friday and is open from 8:00AM to 4:00 PM. During inspection LPA observed eleven (11) children supervised by two staff in room C-2, three (3) children and 1 staff in room B-6 and nine (9) children and 2 staff in room B-7. All staff have obtained criminal record clearance. Sign-in sheet were reviewed, all children present were signed in. All Classrooms were inspected for cleanliness and good repair. LPAs observed age appropriate toys and equipment. Lighting was in operable condition. Children's individual storage space was inspection. There is accessible drinking water in each classroom by a dispenser and disposable cups. The restrooms located in the classrooms were observed to be clean and in operable condition. Appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, and general sanitation. LPA inspected the food preparation area located next to the office. Food preparation area was inspected for cleanliness. Food was observed to be in good quality. The refrigerator was observed it to be clean and in operable condition. Page 1 of 3

Valarie Cook
Alicia Mooberry
	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)

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUDAHY PRESCHOOL ACADEMY	FACILITY NUMBER: 198010922
	VISIT DATE: 03/21/2022

NARRATIVE

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The outdoor play area was inspected for hazards and inaccessibility to bodies of water. At 10:36am LPA observed a shed used for storage located in the children's play area (accessible to children) with the door fallen off the hinges and door placed sideways at the inside entrance to the shed. This poses a potential risk to the health and safety of children in care. Per director the shed does not belong to the facility. LPA observed appropriate shading equipment, benches and toys. Water was available by a dispenser and disposable cups.

First Aid supplies were observed. Disinfectants, cleaning solutions, and other dangerous items to children, were inaccessible. There are no poisons stored at the facility. Smoke detectors and Carbon monoxide detectors were observed and tested to ensure that they are operable.

Menus were posted. This facility prepares meals and provided snacks. The snack items are stored in a cabinet located in the kitchen.

Per Director, there are currently no children on medication.

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

There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file.

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SUPERVISOR'S NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
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)

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUDAHY PRESCHOOL ACADEMY	FACILITY NUMBER: 198010922
	VISIT DATE: 03/21/2022

NARRATIVE

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Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 02/24/22.

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

The facility if following COVID-19 protocols including mask wearing.

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.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22.

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 report was reviewed with Director, Adol Vergara.

-----Page 3 of 3

SUPERVISOR'S NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
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)

Page: 3 of 4

Document Has Been Signed on 03/21/2022 01:53 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 03/21/2022 at 12:58 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUDAHY PRESCHOOL ACADEMY	FACILITY NUMBER: 198010922
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations the licensee did not comply with the section cited above due to a shed located on the children play area and accessible to children was observed to have a broken door. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/01/2022
	Plan of Correction
1 2 3 4	Per Director, the shed will be repaired, photos of the shed will be sent to LPA via email by POC due date.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

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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