198400108-9-18-2019-54-CC-JMOA-BG5Q3M-20190918114857

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400108
Report Date: 09/18/2019
Date Signed: 09/18/2019 11:49:08 AM

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:	JOHN TRACY CENTER		FACILITY NUMBER:	198400108
ADMINISTRATOR:	CATHLEEN MATHES		FACILITY TYPE:	850
ADDRESS:	2160 WEST ADAMS BLVD		TELEPHONE:	(213) 748-5481
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY:	24	CENSUS: 0	DATE:	09/18/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cathleen Mathes		TIME COMPLETED:	12:00 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) Judy Mora conducted a Pre Licensing inspection on this date. LPA met with Applicant, Cecilia Vanin and Director, Cathleen Mathes. This is a change of location for the John Tracy Clinic, License # 191801651. The application is for a Preschool License. Applicant is requesting a total capacity of 24 children. The proposed program will operate Monday through Friday from 9:00am to 3:30pm. The proposed program is located in a building that also provides other services to the community and to students. No other license held by applicant/licensee. All indoor and outdoor areas identified on the facility sketch were toured during this visit. Per applicant, the entrance to the program will be through the back of the building where the first level of the parking lot is located. The indoor activity space consists of 2 classrooms, Rooms 04 & 05. Director needs to post documents which are required to be posted at the facility. First Aid supplies were inventoried. A first aid kit is kept in each restroom located in each classroom. The Director was submit a photo of a thermometer. Carbon monoxide detectors and smoke detectors are present and in operable condition. The applicant states that the Director's office (Room 019) will be used as the ill isolation area and children will use the staff restroom. The facility will provide AM and PM snack. The children will bring their own lunches. There is a mini refrigerator located in each classroom. Sign in/out procedures will be implemented in each classroom. LPA observed sufficient storage space for children’s belongings. LPA did not observe drinking water readily available indoors and outdoors. Director states that pitchers and disposable cups will be taken outdoors. LPA did not observe storage containers for solid waste, including moveable bins. Applicant will need to purchase containers. Cleaning compounds and any poisons are stored in area that is off limits to children. *REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/18/2019

NARRATIVE

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The playground is located directly outside of the preschool program classrooms. The surface of the outdoor activity space is in a safe condition and free of hazards. The outdoor activity space was observed to have adequate shading. The outdoor area is completely fenced; however, LPA observed one door leading out of the preschool area, to not shut correctly. LPA advised for door to be fixed and requested that a door alarm be placed on. LPA observed that outdoor play equipment and materials have not been placed outdoors. The applicant states that there are no bodies of water, firearms or weapons on the premises and none were observed during this visit.

Incidental Medical Services (IMS) policy was discussed. IMS will not be provided. 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

A fire clearance was granted for 24 children and received by the Department on 09/12/19.

LPA observed a total of 2 toilets and 2 sinks, one toilet and one sink in each classroom. LPA also observed changing tables in these restrooms. LPA measured the facility both indoors and outdoors as follows.

Room 05 allows for 18 children.
Room 04 allows for 11 children.
Total indoor: 29 Children.

Outdoor Play yard allows for 24 children.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/18/2019

NARRATIVE

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The following requirements are needed prior to the applicant obtaining a preschool license:

1. Drinking water both indoors and outdoors.
2. Outdoor play equipment and materials needs to be placed outdoors.
3. Door leading out of the preschool yard needs to be fixed to close correctly.
4. A door alarm needs to be placed on the door located in the outdoor yard.
5. Storage containers for solid waste, including moveable bins, need to be installed.
6. Director needs to post documents which are required to be posted at the facility.
7. A thermometer needs to be available.

Once the above items have been corrected, and all application documents approved, the department will make its determination on whether or not to approve the Applicant for a preschool license.

THE ABOVE CORRECTIONS ARE DUE ON OR BEFORE September 28, 2019.

THE LIC 311, RECORDS TO BE MAINTAINED AT THE FACILITY WAS ISSUED.

The Applicant was advised how to access forms and Regulations online at www.ccld.ca.gov. Applicant was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

SB792 Immunization Requirements for Staff and Employees was discussed. MMR, Pertussis and Flu shots are required for all staff.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/18/2019

NARRATIVE

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LPA advised Applicant that all adults 18 years of age and older providing Care & Supervision and/or have 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 Applicant to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Applicant advised that records must be updated with the required documents immediately, and records for all children and staff must be maintained for three (3) years after separation from the facility.

The Applicant was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to Community Care Licensing (CCL) within the time frame specified by the regulation. Applicant advised to visit www.shotsforschool.org for immunization information.

These forms may also be downloaded from our website: www.ccld.ca.gov

Exit interview conducted with Applicant, and a copy of report was given. Appeal rights were issued and discussed.

*END OF REPORT

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019

LIC809 (FAS) - (06/04)

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