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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013696
Report Date: 02/27/2020
Date Signed: 02/27/2020 04:24:09 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:SPIRIT EARLY INTERVENTION PROGRAMFACILITY NUMBER:
198013696
ADMINISTRATOR:BERNICE BENJAMINFACILITY TYPE:
830
ADDRESS:1412 WEST JEFFERSON BLVD.TELEPHONE:
(323) 228-3060
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY:28CENSUS: 8DATE:
02/27/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Susie Guijardo, DirectorTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual random inspection on 2/27/20 at 2:30 PM. LPA met with Susie Guijardo, Director, who guided analyst on a tour of the facility. This is an infant program which consists of two classrooms. Facility operation hours are Monday to Friday from 6:45 AM to 6:00 PM. Infant center is in a separate location from preschool component #197416919.

All areas identified on this report were inspected. Upon arrival, there were eight children outside with four staff. This program consists of two classrooms, younger infants and older infants. This facility also houses two programs, Early intervention and General Infant. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Classrooms were observed to ensure that infants are never left unattended. All children were observed to be under visual supervision of a teacher at all times.

The following was observed during the tour of the facility:

Children's roster was reviewed and is current. 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 present were signed in. Disaster drill log was available, last drill was conducted on 1/9/2020. LPA observed required licensing documents posted on bulletin board in main classroom.

Furniture and equipment were inspected for age appropriateness and good repair. Toys were observed to be safe, and do not have sharp points, edges, splinters and are not made of small parts that can pose a choking hazard. LPA did not observe any baby walkers or any items that fall into that category present in the facility. All materials and surfaces accessible to children are toxic free. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean.



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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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 5
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: SPIRIT EARLY INTERVENTION PROGRAM
FACILITY NUMBER: 198013696
VISIT DATE: 02/27/2020
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Children have their own cubby to store their belongings. LPA observed Cribs use for infants. Per Director when children are almost two years old they transition to a mat. (LPA discussed Safe Sleep Practices and form provided) Linens are changed daily or more frequently, as needed by staff. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. LPA observed that infant changing tables have a padded surface no less than one-inch-thick and are covered with washable vinyl or plastic. The infant changing tables have raised sides that are at least 3 inches high. LPA observed that infant changing tables are within an arm’s reach of a sink.

Telephone service, heating, lighting and ventilation were evaluated and are in operating condition. Per Director, the isolation for sick infants is with a teacher away from other children. Parents are contacted immediately when children are determined to be ill. Indoor drinking water is readily available via a water dispenser and cups. Children also have their own Sippy cup. First Aid supplies were observed in each classroom.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were observed to be inaccessible. According to the Director, medication is only administered to a child when accompanied with a doctor's note and is stored in the classroom inaccessible to children with the child’s name and date. Director states that there are no poisons stored at the facility and understands that storage areas for poisons must be locked with a key or combination lock.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides AM snack and PM snack for children who eat table food (per needs and service plan). Lunch is provided by parents. At 2:45 LPA observed that bottles, dishes, and containers of food brought by the infant’s authorized representative are not labeled or do not have a date. LPA also observed that formula bottles are being prepared by the staff, which is a violation of Title 22.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.----------------PAGE 2

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: SPIRIT EARLY INTERVENTION PROGRAM
FACILITY NUMBER: 198013696
VISIT DATE: 02/27/2020
NARRATIVE
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Outdoor play equipment was observed to be in good condition, free of sharp, loose 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, swings and slides have cushioning material to absorb a fall. The outdoor area has adequate shade. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Director states there are no weapons or firearms on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Staff Records were reviewed to ensure that a health screening report is on file. Infant Teachers files were reviewed to ensure that teachers present are qualified. Children’s Records were reviewed to ensure that Identification and Emergency form and a Needs and Services Plan are on file.

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.html

Health and Safety Code 1596.7996 Effective January 1, 2019, CCCs and FCCHs are required to provide parents and guardians of children enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations and options for locations of affordable blood lead tests. 2019 Lead flyer Provided.



Technical Support Program (TSP) was discussed and offered to licensee. Licensee was informed that contact person for the TSP program is LPA Marina Pilossian.

AB 2370 Requires that all licensed Child Care Centers that were constructed before January 1, 2010, must test their water for lead within a three-year window, between January 1, 2020 and January 1, 2023, with subsequent testing every 5 years after the date of the first test.
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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SPIRIT EARLY INTERVENTION PROGRAM
FACILITY NUMBER: 198013696
VISIT DATE: 02/27/2020
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LPA advised the Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

The following deficiencies listed on the attached deficiencies page LIC809D 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.


Exit interview was conducted with Director, Susie Guijardo, including, but not limited to Appeal Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: SPIRIT EARLY INTERVENTION PROGRAM
FACILITY NUMBER: 198013696
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2020
Section Cited

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101427(e)(1) (e) Infant Care Food Service The infant's authorized representative may provide formula or breast/mother's milk.(1) Such formula or milk shall be bottled before being accepted by the center.
This requirement was not met as evidenced by:
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Based on observation and interview Director did not ensure bottles were being prepared by parents before accepting them at the facility. This poses a potential Health, Safety or Personal Rights risk to children in care
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Type B
03/02/2020
Section Cited

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 101427(j) Infant Care Food Service (j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.
This requirement was not met as evidenced by:
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Based on observation and interview Director did not ensure food containers were dated and bottels were labeled and dated. This poses a potential Health, Safety or Personal Rights 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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5