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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011002
Report Date: 10/09/2019
Date Signed: 10/09/2019 03:47:23 PM

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:LOS ANGELES ADVENTIST ACADEMYFACILITY NUMBER:
198011002
ADMINISTRATOR:JACQUELINE GALBREATHFACILITY TYPE:
850
ADDRESS:846 E.EL SEGUNDO BOULEVARDTELEPHONE:
(323) 743-8818
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:40CENSUS: 8DATE:
10/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Cassandra Hudson-JohnsonTIME COMPLETED:
03:55 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alicia Mooberry and Seung Lee conducted an unannounced annual random inspection. LPAs met with Cassandra Hudson-Johnson, Director, who guided analysts on tour of facility. This is a preschool program which consists of 2 classrooms.

All areas identified on the Facility Sketch were inspected. The following staff was present during this visit: Little Lambs: Staff#2 with 8 napping children. The other classroom being used is the Brown Bears.

PHYSICAL PLANT- Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director (Licensee) states that there are no poisons on the premises. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing sinks are safe, sanitary and are operating properly. All floors are clean and safe. Food storage areas are kept clean and are 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. The facility was observed to be free of flies, other insects and rodents.

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.



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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2019
Section Cited

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Employees or volunteers at day care center; immunization requirements; records; exemptions

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
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and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. LPAs observed that Staff#1 and Staff#2 did have proof of immunizations on file. This is a potential risk to children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 10/09/2019
NARRATIVE
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FACILITY RECORDS- All individuals present have obtained a criminal record clearance or criminal record exemption. There was at least one person trained in CPR and Pediatric First Aid present during this visit. Educational background, training, and/or experience for each staff present are on file and were reviewed. During staff file review, LPAs observed that Staff #1 and #2 did not have proof of immunization on file. This is a potential risk to children in care. 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.

Snack menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. The facility serves AM snack and PM snack. The children bring their own lunch from home. Snacks are prepared in the sink area in the classroom. This facility does not have a kitchen.

Incidental Medial Services (IMS). Director stated that prescription medications are administered with a written permission slip with instructions. Medication is stored in an off limits box in Director's office. Medications administered can include prescription inhalers and Epi-Pens. The facility does offer Incidental Medical Services (IMS) at this time. LPA advised the licensee that an amendment to the current plan of operation must be submitted in 30 days prior to any changes. Please refer to Section 101173 and 101226 for further information on regulatory requirements.

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


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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 4 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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 10/09/2019
NARRATIVE
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Deficiencies were cited in accordance with title 22 child care center regulations. Please see attached 809D.

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Cassandra Hudson-Johnson, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.






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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4