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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011002
Report Date: 05/31/2023
Date Signed: 06/02/2023 09:36:38 AM


Document Has Been Signed on 06/02/2023 09:36 AM - 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:LOS ANGELES ADVENTIST ACADEMYFACILITY NUMBER:
198011002
ADMINISTRATOR:CASSANDRA HUDSON-JOHNSONFACILITY TYPE:
850
ADDRESS:846 E.EL SEGUNDO BOULEVARDTELEPHONE:
(323) 743-8818
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:40CENSUS: 13DATE:
05/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Cassandra Hudson-Johnson, DirectorTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Alicia Mooberry and Rosaura Valenzuela conducted an unannounced annual inspection on 05/31.23. Upon arrival at 9:27am LPA Mooberry met with Cassandra Hudson-Johnson, Director, who guided analyst on a tour of the facility. This is a preschool program which consists of two classrooms; Classroom 1 and Classroom 2. LPA observed 13 children in Classroom 1 with Zipporah Thomas, Teacher. Facility operation hours are Monday to Thursday 6:30 AM-6:00 PM, Friday from 6:30 AM to 4:30 PM. Sign in sheets we reviewed, all children present were signed in by authorized representative.

All areas identified on the Facility Sketch were inspected to ensure the safety of children and facility compliance with Title 22 Regulations. The facility was observed to be within the license capacity and limitations. Staff have received criminal record clearance.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have individual cubbies to store their belongings. Napping equipment (cots) were observed. Linens are taken home each week to be washed.

Per Director, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms by water fountain in each room, children can bring bottled water. Per Director, the required Lead Testing per Written Directive was conducted however, the report was not available for review.

At approximately 12:30pm LPA Mooberry observed Staff #1 lift Child #1 up and out of their seat, child's feet were observed to be wrapped around the chair as child refused to move, which poses an immediate health, safety or personal rights risk to persons in care.

--------Page 1 - Report Continues

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 05/31/2023
NARRATIVE
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Disinfectants and cleaning solutions were in cabinets inaccessible to children. Currently, there are no children that are taking medication. Director stated medication are maintained labeled with child's name and date in secure location in office. First Aid kits are available in both classrooms. Carbon monoxide detector was tested and operable. The smoke detector was observed to be connected to the fire alarm. The 2A10BC fire extinguisher was observed in both classroom with the service tag indicating last inspected on 7/1/22. Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. LPA observed the surface of the outdoor activity space has pieces of rubber surfacing is missing pieces to the top in multiple locations, which can pose a tripping hazard and potential risk to the health and safety of children in care.

Per Director, the facility is in the process of collecting funds for repairs to the outdoor space. There is adequate shade in the play yard.


The outdoor drinking fountain was observed to be inoperable. Per director, the classroom door is maintained open during outside playtime to allow children to freely go inside and drink water. LPA advised that no children shall be left without the supervision of a teacher at any time.

LPA inspected the bathroom floors and observed them to be in need of cleaning, the director was reminded to ensure the surface are to be maintained clean and safe. All materials accessible to children were observed to be toxic free. There are no firearms stored on the premises. There are no pools or bodies of water at the facility.

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. Inspection of required forms was made and documented on the LIC 857. Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Disaster drill log was available.

Preschoolers bring their own food from home and have the option to bring snacks. The facility provides 2 snack if needed. Snacks are in good quantity and quality in the Director's office. LPA observed the children's lunch containers in children's individual cubbies. Page 2 - Report continues

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 05/31/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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

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

The facility is cited with 1 "A" - Personal Rights deficiency and 3 "B" deficiencies listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.

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.

Upon receipt of today's inspection report, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The Director was provided with LIC 9224 Acknowledgement of Receipt of Licensing Report, a copy signed by children's authorizer representative must be kept in children's file.



Exit interview conducted with the Director Cassandra Hudson-Johnson. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were discussed and a copy provided.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/02/2023 09:36 AM - 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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.3(b)
Indoor Activity Space
(b) The floors of all rooms shall have a surface that is safe and clean.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 3 out of 4 bathrooms have floors with dirt marks, wet and sticky which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/02/2023
Plan of Correction
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The Director stated, they clean the bathroom daily. The Director will purchase a more effective mop and ensure the children's bathrooms are clean.
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in that the proof of lead testing according to the Written Directive, this can pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2023
Plan of Correction
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Per Director, the report will be requested from the company that completed the inspetion and a copy sent to LPA by POC 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) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 06/02/2023 09:36 AM - 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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2

(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.
(2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above LPA observed the surface of the outdoor activity space has pieces of rubber surfacing is missing pieces to the top in multiple locations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2023
Plan of Correction
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Per director, a plan to repair the surface will be completed and submitted to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 06/02/2023 09:36 AM - 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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101223(a)(1)(2)(3)
(a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. (2) To be accorded safe, healthful and comfortable accommodations... (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that Staff #1 lift Child #1 up and out of their seat, child's feet were observed to be wrapped around the chair as child refused to move, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/31/2023
Plan of Correction
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Per Facility Representative, they will use alternative ways to have child comply. LPA provided techical Assistance in regards to Children's Personal Rights. All staff will receive training on dealing with behavior issues in a positve way and include Personal Rights of Children in care. Proof of training will be sent to LPA email by 6/14.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
LIC809 (FAS) - (06/04)
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