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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017622
Report Date: 10/15/2021
Date Signed: 10/15/2021 02:34:29 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:CII/GREEN MEADOWS HEAD STARTFACILITY NUMBER:
198017622
ADMINISTRATOR:MICHELLE SAKATIANFACILITY TYPE:
850
ADDRESS:8835 S. AVALON BLVD.TELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:38CENSUS: 0DATE:
10/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Pamela Miller-Hartzog. Site SupervisorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) T. Tran arrived at the above facility to conduct an unannounced required inspection. Upon entering the facility, LPA observed the consolidated Covid-19 CHHS postings and health screening station. Staff conducted temperature check and logged. LPA met with site supervisor Pamela Miller-Hartzog about 12:35 PM we toured the facility inside and outside. Per staff, today is children non-class day. LPA did not observe any children at the facility.
The facility obtained current pediatric CPR and First Aid for all facility staff members. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.
LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule.
This is a Head Start licensed facility. The facility hours of operation are (8:00 AM – 4:30 PM; Monday-Friday). Per staff, facility keep the same children and staff in the same cohort as possible. Facility provides breakfast, lunch, and snack delivered daily from a private vendor Chefable. Filtered water is accessible with disposable cups. Staff frequently cleaned and disinfected all high-touch surfaces, including toys and learning materials by the use of smog machine filled with vital oxide.
LPA inspected the furniture and equipment for age appropriateness and good repair. Staff rotated learning materials based on children's interest. Telephone service, heating, lighting and ventilation were evaluated. Individual storage for children's belongings and learning materials was observed. Isolation area located in the staff office. Children napping equipment observed to be in good condition. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. All classrooms have trash can with tight lids, first aid supplies, smoke detectors; carbon monoxide/fire extinguishers were observed. A review of medication policy, including administering, labeling, storage, and records was made.
Sign in and out sheet procedures were reviewed. The facility roster was up to date and fire and emergency disaster drills were conducted monthly. Emergency disaster plan is updated and reflected to the current operation. Children and staff records were reviewed and in good order.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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: CII/GREEN MEADOWS HEAD START
FACILITY NUMBER: 198017622
VISIT DATE: 10/15/2021
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Outdoor play area was inspected for free of hazards and inaccessibility to bodies of water. Equipment was inspected for safety, cushioning material, good repair and age appropriateness.
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
LPA recommended facility to stay updated with information related to Covid-19 from the California Department of Public Health (CDPH) guidelines, including Centers for Disease Control and Prevention (CDC) guidelines to help prevent and protect staff and children in care. LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations and PINs. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.
LPA informed of released PIN 21-15 CCLD related to Kidde Trusense Smoke & combination Smoke/Carbon
LPA informed the effects of lead exposure for children between ages 1-6 years old are the most at risk for lead poisoning. A copy of lead exposure was provided.
Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Licensee is reminded that smoking is prohibited on the premises.
Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. Visit: www.mandatedreporterca.com
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.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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: CII/GREEN MEADOWS HEAD START
FACILITY NUMBER: 198017622
VISIT DATE: 10/15/2021
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Licensee [or 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 discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiency was cited. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Pamela Miller-Hartzog.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC809 (FAS) - (06/04)
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