198016571-1-31-2023-33-CC-VMGA-CNLQYJ-20230131113513

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016571
Report Date: 01/31/2023
Date Signed: 01/31/2023 11:36:35 AM

Document Has Been Signed on 01/31/2023 11:36 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ST. DOMINIC SCHOOL		FACILITY NUMBER:	198016571
ADMINISTRATOR:	LUCY CUEVAS		FACILITY TYPE:	850
ADDRESS:	2005 MERTON AVENUE		TELEPHONE:	(323) 255-5803
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY:	40	CENSUS: 8	DATE:	01/31/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Director, Lucy CUevas		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced annual random inspection at the above facility on 01/31/23 at 08:35 AM. A COVID risk assessment was conducted prior to entering the facility. LPA met with director Lucy Cuevas who guided LPA on a tour of the facility. This is a preschool age program licensed for 40 children which operates Monday – Thursday from 08:00 AM – 03:00 PM and Friday 08:00 AM – 01:30 PM. Per the director, there are 10 children enrolled. All areas identified on the Facility Sketch were inspected. This preschool is licensed for 4 classrooms. Only 2 classrooms are in use at this time: the Academic Room and Play Room. The following staff was present during this inspection: Academic Room 8 children with 2 staff, Play Area Room 0 children and 0 staff. Play Area Room is used for play. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded on the attached LIC859. All children were observed to be under supervision, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license. LPA observed the facility to be clean, sanitary and in good repair. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All floors are safe and clean. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Drinking water was readily available indoors and outdoors. LPA observed mats stored as napping equipment in Play Area Room and in the storage closet. All toilets and hand washing facilities are safe, sanitary and are operating properly. At this time, the Academic Room is used as an isolation area. A cot is available for an ill child to rest on. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. 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. The facility was observed to be free of flies, other insects, and rodents. Page 1 of 3

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. DOMINIC SCHOOL	FACILITY NUMBER: 198016571
	VISIT DATE: 01/31/2023

NARRATIVE

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LPA observed all required forms/publications to be posted in the Play Area Room. Parents provide lunch and snacks for the children; however, the facility does have snacks, water bottles, gallon of water with cups and juice available to children. All food and beverages are stored in covered containers. LPA observed a refrigerator used to store the children's water and juice located in the Play Room.

First Aid supplies are available, complete, and are kept in the Academic Room. Facility has a functioning combination carbon monoxide and smoke detector that meets statutory requirements. Two fire extinguishers were observed. The valve on the required 2A 10BC fire extinguisher located in the Play Area room indicates fully charged and was serviced on 11/02/22, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Director states there are no weapons, firearms, or bodies of water on the premises.

At 08:50 AM the outdoor play equipment was observed to be in good condition, free of sharp, lose 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, have cushioning material to absorb a fall. There is adequate shade in the play yard.

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’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Children’s records were observed to be complete. Staff Records were reviewed to ensure that appropriate documentation of education credits is on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. Proof of immunization against influenza, pertussis and measles for staff was readily available during today's inspection. Staff # 2 did not have a current Mandated Reporter Training as required. LPA issued a technical violation.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ST. DOMINIC SCHOOL	FACILITY NUMBER: 198016571
	VISIT DATE: 01/31/2023

NARRATIVE

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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 Sections 101173 and 101226.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

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.

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/process

LPA advised the licensee how to access forms, regulations, and quarterly updates online at: www.ccld.ca.gov.

At this time, the director is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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.

Exit interview conducted and report was reviewed with director Lucy Cuevas and appeal rights were provided.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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