198015308-6-23-2022-54-CC-JESA-CFNVKE-20220623163013

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015308
Report Date: 06/23/2022
Date Signed: 06/23/2022 04:30:39 PM

Document Has Been Signed on 06/23/2022 04:30 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:	WEST SIDE		FACILITY NUMBER:	198015308
ADMINISTRATOR:	LETICIA RICO NUNEZ		FACILITY TYPE:	850
ADDRESS:	9200 STATE STREET		TELEPHONE:	(323) 563-0067
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	80	CENSUS: 26	DATE:	06/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Lety Martinez Child Development		TIME COMPLETED:	04:45 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	On 6/23/22 Licensing Program Analysts (LPAs) Jeanette Estrada and Austin Estrada conducted an unannounced required 1 year inspection. LPAs met with Child Development Coordinator Leticia Martinez who guided analysts on a tour of the facility. LPAs provided Facility Entrance Checklist to Facility Representative. This is a preschool program which consists of 4 classrooms. Three out of the four classrooms operate 12 months and one classroom operates 10 months. Classroom 1 had 6 children in attendance with 3 staff, classroom 2 had 9 children in attendance with 2 staff and classroom 3 had 11 children in attendance with 2 staff. Classroom 4 was not in session during this inspection. Operating hours are 8AM to 2:30PM Monday to Friday. The facility provides services to children ages 3-5 years old. 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 cubbies in each classroom to store their belongings. Napping cots are available for rest time. Per facility representative the sleeping linens are sent home on a weekly basis. There is an isolation area in each classroom away from other children. The isolation restroom is the staff restroom in the hall way. There are two restrooms available for children in the facility. Classroom 1 and 2 use restroom 1. Restroom 1 has 4 sinks and 4 toilets. Classrooms 3 and 4 use restroom 2. Restroom 2 has 2 sinks and 2 toilets. General sanitation was observed in each restroom. Availability of indoor drinking water was observed in classrooms via water dispensers. Per Facility Representative, disposable cups are used and staff assist children. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Cleaning supplies are stored in high cabinets inaccessible to children. Each classroom has a medication box that locks and is kept out of reach of children. Per Facility Representative there are no poisons stored at the facility. There is at least one operable carbon monoxide/ smoke detector in the facility. The facility has a central fire alarm installed. Each classroom contains a first aid kit. First aid kits were inventoried.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: WEST SIDE	FACILITY NUMBER: 198015308
	VISIT DATE: 06/23/2022

NARRATIVE

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The outdoor playground area was evaluated. The outdoor playground is fully fenced. 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 water dispenser. Per Facility Representative, the water dispenser is taken outside during outdoor play time. Per Facility Representative there are no firearms stored on the premises. There are no pools or bodies of water at the facility. There is a 2A10BC fire extinguisher in each classroom which were last serviced on 6/2022.
There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed for completeness. 2 out of 12 children did not have a physcian's report on file. 4 out of 12 children did not have LIC 627 on file. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. Facility Representative, Leticia Martinez was informed of records that would be reviewed via the facility entrance checklist. Per Facility Representative staff records are kept off site. At 1:00 PM LPAs were notified that staff files were being scanned to the facility for LPAs to review. LPAs began staff file review at 1:30 PM. The review of Staff records was documented on the LIC 859. All staff present did not have current proof of the AB 1207 Mandated Reporter Training certificate on file. All staff present did not have proof against, measles, pertussis, and influenza.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Disaster drill logs were available. Each classroom conducts separate drills. The last drills documented are as follows: Classroom 1 and classroom 2 5/18/22, Classroom 3 6/9/22.
Menus are provided to parents/ authorized representatives one month in advance and the menus are also posted in the classrooms. Menus for the past 30 days are available upon request. The facility provides breakfast, lunch and a PM snack. The facility provides the meals through and an outside vendor, Tender Loving Care Catering INC. 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: WEST SIDE	FACILITY NUMBER: 198015308
	VISIT DATE: 06/23/2022

NARRATIVE

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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 or solid waste bags shall be discarded immediately after each meal. Per Facility Representative children with allergies are provided alternate foods by the vendor. LPA observed allergy lists posted in each classroom and in the kitchen area.

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

Facility Representative 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.

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.

CONTINUED ON PAGE 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/23/2022 04:30 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: WEST SIDE	FACILITY NUMBER: 198015308
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, staff 1 Annie Pulido Avalos and Staff 2 Neli Rangel were present in the facility on 6/23/22. Staff 1 and staff 2 are not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/24/2022
	Plan of Correction
1 2 3 4	Facility Representative will submit the LIC 9182 transfer request to the RO 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	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/23/2022 04:30 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: WEST SIDE	FACILITY NUMBER: 198015308
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) 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, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 8 staff who did not have proof of required immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2022
	Plan of Correction
1 2 3 4	Facility representative will submit POC by Due date

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
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 5 out of 8 staff who do not have a current Mandater reporter certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2022
	Plan of Correction
1 2 3 4	Facility representative will submit POC 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 Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/23/2022 04:30 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: WEST SIDE	FACILITY NUMBER: 198015308
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 12 children did not have a physician report on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2022
	Plan of Correction
1 2 3 4	Facility representative will submit POC by Due date

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 4 out of 12 children did not have LIC 627 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2022
	Plan of Correction
1 2 3 4	Facility representative will submit POC 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 Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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: WEST SIDE	FACILITY NUMBER: 198015308
	VISIT DATE: 06/23/2022

NARRATIVE

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A civil penalty is being assessed today due as Annie Pulido Avalos and Neli Rangel were present during the visit on 6/23/22 & are not associated as required. Per Facility representative, both staff are substitutes and were present for one day.
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.

LPAs Jeanette Estrada and Austin Estrada informed licensee Facility Representative Leticia Martinez that this report dated 6/23/22 document(s)
1 Type A citation which shall be posted for
30 consecutive days as there is/are immediate risk(s) to the health, safety,
or personal rights of children in care.
Also, LPAs Jeanette Estrada and Austin Estrada informed the facility
representative to provide a copy of this licensing report dated 6/23/22 that documents any Type A citation(s) to parents/guardians of
all children currently enrolled by the next business day or the next day the
children are in care, and to any newly enrolled parents/guardians for 12
months from the date of this report. A signed Acknowledgement of Receipt
of Licensing Report (LIC 9224), or other written statement, must be placed
in the child's file for verification.

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 Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC809 (FAS) - (06/04)

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