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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020073
Report Date: 02/17/2022
Date Signed: 02/17/2022 12:34:54 PM


Document Has Been Signed on 02/17/2022 12:34 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:HOLY TRINITY PRESCHOOLFACILITY NUMBER:
198020073
ADMINISTRATOR:LEODIVINA CRUZFACILITY TYPE:
850
ADDRESS:3908 WOODRUFF AVETELEPHONE:
(562) 425-0580
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:30CENSUS: 4DATE:
02/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Leodivina CruzTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 1 Year Inspection. LPA met with Director Leodivina Cruz who assisted analyst with a tour of the facility. This is a preschool program serving children ages two (2) until six (6) years old. The hours of operation are 7:00am to 5:30pm Monday through Friday.

All areas identified on the Facility Sketch were inspected. At 8:35am LPA observed: Room 1 (One staff and one child); Room 2 (zero staff and zero children). Note: Room two (2) is used as a nap room at this time until enrollment picks up. Between 8:35am and 9:00am Three more children arrived along with cleared assistant.

From 8:35am through 9:35am LPA observed furniture and equipment was inspected for age appropriateness and good repair. LPA also observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate storage for their belongings as each child has individual cubbies. Napping cots are stored outside the classrooms in a separate area. LPA observed small drinking water bottles readily available in the classrooms. At 9:20am LPA observed one toilet that continuously flushes. Director Cruz immediately contacted the maintenance staff to set up date for repair. The other age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, safety and sanitation (They were in good repair and operating condition). All indoor classrooms have surfaces that appear to be clean and safe. All materials and surfaces accessible to children are toxic free. Storage areas for poisons are locked. At this time, the office is used as an isolation area to care for ill children. Mats, chairs and a staff restroom is available for children to use if they are ill. Parents are contacted immediately as well.



At approximately 9:35 LPA observed outdoor play equipment to be in adequate condition, free of sharp, loose or pointed parts. LPA advised Director to consider upgrading play equipment soon. The outdoor activity space appears to be free of hazards. Areas around and/or under climbing equipment have cushioning material to absorb a fall. LPA advised Director to add more sand as eventually the sand cushioning deteriorates.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022
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: HOLY TRINITY PRESCHOOL
FACILITY NUMBER: 198020073
VISIT DATE: 02/17/2022
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Director Cruz indicated that there are no bodies of water on the premises and LPA did not observe any bodies of water during today's inspection.

From 10:00am to 10:15am LPA reviewed snack menus and observed that they are being posted at least one week in advance and visible to an authorized representative. The facility provides an AM snack and PM snack and parents provide lunch. Food and snack preparation areas were toured for safety, cleanliness and proper equipment. LPA observed an adequate amount of food available for children in care at this time. LPA observed dates on food and reminded Director to label dates on items taken out of the package. LPA observed drinking water available for children indoors and outdoors. Trash receptacles have tight fitting covers and are in good repair.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. The facility has one or more functioning smoke detectors and carbon monoxide detectors that meet statutory requirements. The required 2A10BC fire extinguisher gauge is in the green and has been serviced within the last 12 months (Last service date March 26, 2022).

LPA reviewed sign in and sign out forms to ensure children are being properly signed in and signed out. LPA conducted a Children's Records Review to ensure children have Identification and Emergency forms, Immunization records, Health History, Personal Rights and Parents Rights on file.

At 10:00 LPA reviewed staff records to ensure the following: Appropriate documentation of education credits, Criminal Record Clearance documents available, Verification of current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination available. Director Cruz CPR expires November 2022

All paperwork was readily available during today's inspection. LPA advised Director Cruz to occasionally conduct spot check audits to ensure constant compliance for children's files and staff files (especially for expiring requirements such as CPR and Mandated reporter training). LPA observed Director and Staff Mandated Reporter expired in 2020.

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

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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: HOLY TRINITY PRESCHOOL
FACILITY NUMBER: 198020073
VISIT DATE: 02/17/2022
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At 8:40am-9:00am LPA observed First Aid supplies in each classroom. Director Cruz indicated that medication is only administered to children once parent's provide a doctor's note. All medications are stored in a high kitchen cabinet or locked box in refrigerator for inaccessibility. LPA informed Director that fire extinguishers type 2A-10BC must be serviced at least annually. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Any construction or remodeling should be reported to the Department before it occurs. .

Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. LPA advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.



LPA advised Director Cruz that all adults 18 years of age and older providing Care & Supervision and having a continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. All care for children require supervision at all times. If away from the facility, staff must be with children at all times (especially when outdoors). There were no violations of Title 22 requirements at this time.

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.

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 Exit interview was conducted with Director Leodovina Cruz and a copy of Appeal Rights (LIC 9058) was discussed and provided

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/17/2022 12:34 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: HOLY TRINITY PRESCHOOL
FACILITY NUMBER: 198020073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as LPA observed a toilet that was not functioning properly (continuos flush) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2022
Plan of Correction
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Director Cruz indicated she will have maintennace repair within 20- days.
Note: enrollment is low so one toilet may suffice until 30 days.
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
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Based on record review)], the licensee did not comply with the section cited above in two of two staff have expired Mandated Reporter training (expired in 2020). This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2022
Plan of Correction
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Director will have staff renew Mandated reporter and submit evidence 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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4