198016407-8-23-2019-33-CC-LGOZ-BFBSHZ-20190823135422

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016407
Report Date: 08/23/2019
Date Signed: 08/23/2019 01:54:34 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	CII/OTIS BOOTH CDC		FACILITY NUMBER:	198016407
ADMINISTRATOR:	LILIANA RUBIO		FACILITY TYPE:	850
ADDRESS:	424 N. LAKE STREET		TELEPHONE:	(213) 260-7717
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90028
CAPACITY:	48	CENSUS: 13	DATE:	08/23/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Daniela Troya		TIME COMPLETED:	02:09 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	An unannounced Case Management-Licensee initiated inspection was conducted on this date by Licensing Program Analyst (LPA) Lissete Gonzalez in order to take measurements of the indoors and of the outdoor play space of a proposed Toddler component to be added on to an existing pre-school license. The application was received by the Department on 07/23/19. CII/Otis Booth CDC is requesting to add 16 toddlers to the existing pre-school license and decrease the preschool capacity to 24 preschoolers. The Preschool program is currently licensed for forty-eight (48) preschoolers. Upon arrival, LPA met with Senior Early Childhood Service Manager, Daniela Toya who guided LPA Gonzalez to Toddler Room 1 and Toddler Room 2 where care will be provided and then to the Preschool Room B. Census in Room B: There were 13 preschoolers with five staff. Staff-child ratio was met. Also present were the Site Supervisor, Liliana Rubio Samayoa, Early Childhood Services Manager, Hyunsun Park. The proposed toddler rooms are Toddler Room 1 and Toddler Room 2. The preschool classroom is Room B. To get to the toddler rooms and the preschool room, one would enter through the main entrance door and head South down the hallway where the classrooms are located to the right. The Center will operate year-round. The proposed days and hours of operation are Monday - Friday 7:30 a.m. to 5:00 p.m. The facility will provide a full day session to children in Preschool and Toddler option. All posting requirements were observed on the Parent Board, which is located on the parent wall to the right-hand side of the hallway outside the classrooms. There is a monthly menu posted on the parent board. The daily class schedules are posted in the classrooms’ bulletin board. Breakfast, lunch, and a P.M. snack will be served. All food is provided by CII/Otis Booth CDC. Breakfast is served at 8:30 a.m., lunch is served at 11:00 a.m. and at 2:50 p.m. the P.M. snack is served. REPORT CONTINUES ON NEXT PAGE: 1 OF 4

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CII/OTIS BOOTH CDC	FACILITY NUMBER: 198016407
	VISIT DATE: 08/23/2019

NARRATIVE

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Toddler Room C-113 (Toddler 1) has one bathroom with 2 toilets and 2 sinks. The bathroom consists of child-size toilet and a child -size sinks. The room has a changing table and there is a sink within arm’s reach.

Toddler Room C-114 (Toddler 2) has one bathroom with 2 toilets and 2 sinks. The consists of child-size toilet and a child -size sinks. The room has a changing table and there is a sink within arm’s reach.

Preschool Room C-115 (B) was inspected. LPA observed one bathroom with 2 toilets and 2 sinks.

There is age-appropriate furniture and equipment in each classroom. There is a landline in each classroom. The classrooms have central heating and air-conditioning. Overhead lighting provides majority of the light. For napping equipment, there are eight cots available in each toddler classroom. Drinking water will be dispensed from a portable water dispenser with individual disposable cups in each classroom.

The kitchen will be used to store food items. The food will be prepared at CII’s Mid-Wilshire facility location and delivered to the facility daily. Food items will be kept warm using food warmers. In addition to the food warmers, there are 2 sinks, food storage space, dishwashers, a microwave oven, and a full-size commercial refrigerator with designated storage for the toddler’s food items in the kitchen.

When a toddler becomes ill during school hours, the Center will use the Director’s office as the isolation area. There is a cot available in the Director’s office. There is a diaper changing table located in the adult bathroom where the toddlers in isolation will be changed.

The outdoor toddler activity area is fenced. The play yard has foam rubber cushioning under the play activity areas and equipment. Drinking water will be dispensed from a portable water dispenser with individual, disposable cups. LPA observed an exit door in Toddler Room 2 leading to the toddler playground where a fence separates the Toddler and Preschool playgrounds. The exits in the Toddler Room 1 and Toddler Room 2 classrooms lead directly to the toddler playground.

The outdoor Preschool activity area was inspected. The play yard has foam rubber cushioning throughout majority of the play activity areas and equipment. Drinking water will be dispensed from a portable water

REPORT CONTINUES ON NEXT PAGE: 2 OF 4

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CII/OTIS BOOTH CDC	FACILITY NUMBER: 198016407
	VISIT DATE: 08/23/2019

NARRATIVE

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dispenser with individual, disposable cups.

There is a fire extinguisher mounted on the wall on the hallway outside of the Toddler classrooms and a second fire extinguisher located in the kitchen. It was last serviced 07/31/19. There are fire alarms, carbon monoxide detectors and smoke detectors in the classrooms.

The encumbered space in Toddler Room 1 are the parent sign in table, the adult sink, and the stored cots. The encumbered space in Toddler Room 2 are the parent sign in table, the adult sink, the stored cots, and a pillar located by the adult sink. The encumbered space on the Toddler playground is the ground plant nursery space.
LPA re-measured the preschool classroom and playground. The encumbered space in Preschool Room B are the parent sign in table, the adult sink, and a pillar located by the adult sink. The encumbered space on the preschool playground are the ground plant nursery space, a storage cabinet, an adult sink, a water hose storage unit, and 2 planters.

Based on measurements taken on this date, the maximum indoor capacity shall be for 16 toddlers and 22 preschoolers. Based on measurements taken on this date, the maximum outdoor capacity for the toddler playground shall be for 16 toddlers. Applicant is currently applying for 16 toddlers and 24 preschoolers. Fire clearance was granted on 07/29/19.

Incidental Medical Services: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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.

Medications which require refrigeration will labeled and be stored in the commercial refrigerator located in the kitchen. Medications which do not require refrigeration will be labeled stored in a backpack available in each classroom that is stored out of reach of children. The cleaning supplies will be kept in the cabinet located underneath the adult sink with a child proof latch on it for each classroom.
REPORT CONTINUES ON NEXT PAGE: 3 OF 4

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CII/OTIS BOOTH CDC	FACILITY NUMBER: 198016407
	VISIT DATE: 08/23/2019

NARRATIVE

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An exit interview has been conducted with and a copy of this report has been signed by and provided to Senior Early Childhood Service Manager, Daniela Toya. Appeal Rights have been provided and explained.

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.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

LIC809 (FAS) - (06/04)

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