<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017600
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:25:53 PM


Document Has Been Signed on 09/08/2022 02:25 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:PACIFIC CLINICS VERDUGO HEAD STARTFACILITY NUMBER:
198017600
ADMINISTRATOR:KIMIKO ZITTERFACILITY TYPE:
850
ADDRESS:1003 S. VERDUGO ROADTELEPHONE:
(818) 241-4729
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:31CENSUS: 12DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Azo Deukmejian, Site SupervisorTIME COMPLETED:
02:30 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
Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection on 09/08/2022 at 11:20 AM. LPA met with Kumiko Zitter, Designated teacher to act as director. Shortly after Azo Deukmejian, Site Supervisor arrived to the facility who guided analyst on a tour of the facility. This is a preschool program which consists of 2 classrooms; RM 1 and RM 2 (3-5 years old). This facility is located on La Magdelena Episcopal Church property. Facility operation hours are from Monday to Friday from 8:00 AM to 4:00 PM. LPA provided Azo Deukmejian, Site Supervisor with a copy of the Entrance Checklist for Child Care Centers form (LIC 125).

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection; RM 1: 6 preschoolers with 3 staff having lunch and RM 2: 6 preschoolers with 3 staff having lunch. The facility was observed to be within the license capacity and limitations. Staff names were recorded. 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:

PHYSICAL PLANT
LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for age appropriateness and good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials accessible to children were observed to be toxic-free. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings inside the classroom. Parents take Linens home each week on Friday or as needed and return it on Monday. Napping equipment (cots) were observed to be stored on a rolling storage in the staff room and staff take it to the classrooms daily for nap time. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. LPA observed water dispensers and disposable cups in each classroom.
REPORT CONTINUES ON NEXT PAGE 1 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PACIFIC CLINICS VERDUGO HEAD START
FACILITY NUMBER: 198017600
VISIT DATE: 09/08/2022
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
26
27
28
29
30
31
32
Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Per Site Supervisor, Azo Deukmejian states there are no poisons stored at the facility. Azo Deukmejian tested the carbon monoxide detectors in the RM 1. It sounded off the alarms and heard by LPA to be functional. LPA observed 2A 10BC Fire Extinguisher in each classroom. It was serviced on 09/10/2021 as read by LPA from the service tag.

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. Facility use the church kitchen sink area sink, dishwasher and program warmer that is placed in the kitchen by sink area. 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.

Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The outdoor playare is located at the back of the building. There is a door in each classroom which leads to the outdoor playarea. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with rubber flooring cushioning material that absorbs a fall; climbing apparatuses are single level only. There is adequate shade in the play yard. There is a cement area which is used as bike area. Availability of outdoor drinking water was observed. LPA observed water dispenser with disposable cups on the outdoor playarea. LPA advised that no children shall be left without the supervision of a teacher at any time.

Azo Deukmejian, Site Supervisor states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this inspection. Director states there are no weapons or firearms on the premises. LPA observed posting requirement were posted inside each classroom.
FACILITY RECORDS
Azo Deukmejian, 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.
Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.
REPORT CONTINUES ON NEXT PAGE 2 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PACIFIC CLINICS VERDUGO HEAD START
FACILITY NUMBER: 198017600
VISIT DATE: 09/08/2022
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
26
27
28
29
30
31
32
There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPA also reviewed 6 staff records. The review of Staff records was documented on the LIC 859. Staff present had proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof against TB, measles, pertussis, and influenza. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions.

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. LPA observed sign in/out sheet was placed outside of each classroom. During this inspection 12 children were present and all 12 children were singed in. Disaster drill log was available, last drill was conducted on 08/30/2022.



Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. Meals and snacks are brought in by a catering service to the kitchen. Head Start nutritionist oversees meals that are prepared. Breakfast, lunch, and afternoon snack are served to children. Meals and snacks are eaten family style.

First Aid supplies were observed in each classroom. According to Site supervisor, medication is only administered to a child when accompanied with a doctor's note and is stored in the child’s classroom. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the staff office. The ill child will use the staff restroom during isolation which is disinfected immediately after use per Site Supervisor.

Medication: 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. Plan of Operation for Incidental Medical Services was submitted on 02/28/2017.
REPORT CONTINUES ON NEXT PAGE 3 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 3 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PACIFIC CLINICS VERDUGO HEAD START
FACILITY NUMBER: 198017600
VISIT DATE: 09/08/2022
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
26
27
28
29
30
31
32
LPA advised the licensee 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/process.

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

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Site Supervisor, Azo Deukmejian at 2:30 p.m..


END OF REPORT PAGE 4 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4