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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011377
Report Date: 04/25/2022
Date Signed: 04/25/2022 02:49:13 PM


Document Has Been Signed on 04/25/2022 02:49 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:PASITOS SAN MIGUEL PRE-KINDERGARTEN ACADEMYFACILITY NUMBER:
198011377
ADMINISTRATOR:LETICIA RICO NUNEZFACILITY TYPE:
850
ADDRESS:9801 SAN MIGUEL AVENUETELEPHONE:
(323) 513-0594
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:15CENSUS: 0DATE:
04/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Lead Teacher Martha Garcia TIME COMPLETED:
03:00 PM
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On 4/25/22 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection. LPA met with Lead Teacher Martha Garcia who guided analyst on a tour of the facility. This is a preschool program which consists of one single classroom and operates from Tuesday through Friday. Mondays are non-instruction days. Program operates in two sessions: The AM session operates from 8:30AM to 12:00PM and the PM session operates from 12:45 PM to 4:00 PM. Present during today's inspection were 2 staff. No children were present today. LPA provided Facility Entrance Checklist to Lead Teacher.
This facility is located in the back side of the property of San Miguel Avenue Elementary School. Facility entrance is located off of San Luis Street. All areas identified on the facility sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. There is no nap at this facility due to it being a half day program. The isolation area is located in the library area. The age appropriate sink and toilet was inspected for availability and good repair. There is one toilet and one sink available for children in care. General sanitation was observed. Availability of indoor drinking water was observed in classrooms via a Brita water dispenser. Teachers assist children with the drinking water. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Per Lead Teacher, there are no poisons stored at the facility and medications would be stored in a container in an upper cabinet above the sink. Per Lead Teacher, there are no children who require medication at this time. A combination Carbon monoxide/ smoke detector was observed in the classroom but could not be checked if it was operable. The classroom has a fire alarm installed.
The outdoor playground area was evaluated. Outdoor equipment is in a safe condition, free of sharp, loose or pointed parts. All areas around or under high climbing equipment and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed via a Brita water dispenser. Per Lead Teacher, the water dispenser is taken outside during outdoor play time.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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: PASITOS SAN MIGUEL PRE-KINDERGARTEN ACADEMY
FACILITY NUMBER: 198011377
VISIT DATE: 04/25/2022
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Per Teacher there are no firearms stored on the premises. There are no pools or bodies of water at the facility. The 2A10BC fire extinguisher is located by the play yard entrance and was last serviced on 4/2022
Site Supervisor 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.
There is at least one person trained in CPR and Pediatric First Aid present during this inspection. 2 out of 2 staff present had a current certification on file. Staff 1 and Staff 2 certification expires 4/2023.

Children’s Records were reviewed for completeness. (The name, address, and telephone number of child’s authorized representative and medical assessment are on file). 8 out of 10 Children's files did not have LIC 613A signed by a parent or authorized representative. 9 out of 10 children's file did not have LIC 995 signed by a parent or authorized representative. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. Site Supervisor Coralia Dolmuz was informed of records that would be reviewed via the facility entrance checklist. Per Site Supervisor, staff records are kept off site but stated records would be brought over to the facility for review. Staff records provided to LPA during inspection were incomplete and Site supervisor returned to office to obtain missing records. The review of Staff records was documented on the LIC 859. Staff present did not have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present did have proof against TB, measles, pertussis, and influenza. Staff 1 did not have LIC 503 for review.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Disaster drill log was available, last drills were conducted on 4/21/22.
Menus are provided to parents/ authorized representatives one month in advance and it is posted in the classroom. Menus for the past 30 days are available upon request. The facility provides breakfast and lunch for the AM session and Lunch and a snack for the PM session. The facility provides the meals through and an outside vendor, Tender Loving Care Catering INC. First Aid supplies were observed in the classroom mounted on a wall, accessible to staff.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022
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: PASITOS SAN MIGUEL PRE-KINDERGARTEN ACADEMY
FACILITY NUMBER: 198011377
VISIT DATE: 04/25/2022
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Incidental Medical Services (IMS) policy was discussed. LPA provided PIN 22-02-CCP 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

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


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 deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. 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 Appeal Rights and report were reviewed with the facility representative .

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/25/2022 02:49 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: PASITOS SAN MIGUEL PRE-KINDERGARTEN ACADEMY

FACILITY NUMBER: 198011377

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 staff records which did not have a current mandated reporter training certificate available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/25/2022
Plan of Correction
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Per facility representative Mandated Reporter Training will be completed and certificates will be submitted to LPA via email by due date.
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 8 out of 10 children's records which did not have LIC 613A signed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/25/2022
Plan of Correction
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Per facility representative, proof of signed LIC 613A will be submitted by 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) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4