198400108-9-10-2021-54-CC-DGIS-C6Q25N-20210909170551

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400108
Report Date: 09/09/2021
Date Signed: 09/10/2021 08:23:45 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: 9	DATE:	09/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Bridgette Klaus, Facility Representative		TIME COMPLETED:	05:15 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) Denise Gibbs conducted an unannounced annual inspection on 9/9/2021 at 1:50 PM. LPA met with Bridgette Klaus, Facility Representative (FR), who guided analyst on a tour of the facility. This is a preschool program which consists of two classrooms. Facility operation hours are Monday to Thursday from 9:00 AM to 3:00 PM and Friday 9:00AM - 12:00PM.

All areas identified on this report were inspected. Upon arrival LPA observed nine children and three staff. Teacher-Child ratios were observed to be in accordance with Title 22 Regulations. 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:

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 present were signed in. Disaster drill log was available, last drill was conducted on 8/19/2021. LPA observed required licensing documents posted on bulletin board in the hallway outside of the children's classrooms. LPA reviewed daily activity schedule which provides time for active play, quiet play, rest, eating and toileting. Facility disaster plan was observed and is complete.

Furniture and equipment were inspected for age appropriateness and good repair. LPA observed material and equipment are free of sharp, loose, or pointed parts. Telephone service, heating, lighting and ventilation were evaluated and are operable. There is at least one operable carbon monoxide detector.

Disinfectants, cleaning solutions and other items that are dangerous to children, were observed to be inaccessible in a high cabinet in the classroom. According to the FR, short term medication is not administered. -------------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/09/2021

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

at the facility. Life long or life saving medication would be stored in the child's classroom in a high shelf, inaccessible to children. Per FR, there are no children who take medication at this time. FR states that there are no poisons stored at the facility and understands that storage areas for poisons must be locked.

Menus were reviewed to ensure that they are being posted at least one week in advance and are visible to an authorized representative. The facility provides AM snack and PM snack, lunch is brought from home.

Facility stores AM and PM snack in refrigerators in the classroom. Kitchen area on second floor is not used for children's food preparation. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

Outdoor play equipment was observed to be in good condition, free of sharp, loose 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. FR states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. FR states there are no weapons or firearms on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. All staff present are trained in CPR and Pediatric First Aid, certificates are current..

Staff’s Records were reviewed and are complete. Children's records were reviewed and are missing LIC 701, Physician's report.

LPA observed that facility is implementing COVID-19 precautions and procedures. LPA was provided with COVID-19 facility assessment checklist.

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.html

-------------------PAGE 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/09/2021

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

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.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the FR, Bridgette Klaus

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 4 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the Facility Representative did not comply with the section cited above in 9 out of 9 physicians reports were missing for children 1-9 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2021
	Plan of Correction
1 2 3 4	Per Facility Representative, she will add the physician's report to the enrollment packet for new children and have current families return the form by 10/11/21 and email copies to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4