191222366-9-27-2024-58-CC-ECAO-D9HPF6-20240927111612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222366
Report Date: 09/27/2024
Date Signed: 09/27/2024 11:31:12 AM

Document Has Been Signed on 09/27/2024 11:31 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM		FACILITY NUMBER:	191222366
ADMINISTRATOR:	LARA NALBANDIAN		FACILITY TYPE:	850
ADDRESS:	22005 DEVONSHIRE ST.		TELEPHONE:	(818) 481-4583
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	72	CENSUS: 3	DATE:	09/27/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	06:40 AM
MET WITH:	Anthony Jauregui, Acting Site Supervisor		TIME COMPLETED:	11:30 AM

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	On 09/27/2024 at 06:40 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Annual Required Inspection. Facility is located on Chatworth Park Urban Planning Magnet School Campus at 22005 Devonshire Street, Chatsworth, CA 91311. LPA identified self and met with Anthony Jauregui, Acting Site Supervisor, LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection. Facility Representative (FR) Anthony Jauregui, Acting Site Supervisor allowed entry to facility and provided LPA a guided tour of inside and outside of the facility. The facility is currently licensed for a capacity of 72, per FR they currently have 14 enrolled. The facility hours of operation are currently Monday thru Friday from 06:30 AM to 08:00 AM and 01:00 PM to 06:30 PM. Required postings were observed posted in Multi Purpose Room #14. Upon arrival LPA observed, the facility no longer has a designated classroom and moves from the Library and the Mult Purpose Room #14. The Department did not receive prior notification for the movement of the physical location of the license facility. The Library and Multi Purpose Room are used for ages 5 year olds to 13 year olds, 1 staff. PAGE 1 OF 4

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

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 7

Document Has Been Signed on 09/27/2024 11:31 AM - 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: 31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM	FACILITY NUMBER: 191222366
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in that the Lead Testing Report was not readily available to the Department upon request which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Acting Site Supervisor stating that they will obtain a copy of the report from the School District and will provide LPA a copy by email the plan of correction due date 10/25/2024.

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
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in that Staff #2, Staff #3, Staff #4 Completion of Mandated Reporter Certificate was not readily available upon Department Request which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Acting Site Supervisor stated that they will obtain a copy of the Mandated Reporter Completion Certificate and will provide LPA a copy by email the plan of correction due date 10/25/2024.

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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/27/2024 11:31 AM - 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: 31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM	FACILITY NUMBER: 191222366
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in that Staff #2 and Staff #3 did not have proof o immunization record readily available upon Department request which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Acting Site Supervisor stating that they will obtain a copy of the immunizaiton records for Staff #2 and Staff #3 and will provide LPA a copy by email the plan of correction due date 10/25/2024.

Type B

Section Cited

CCR

101217(a)(12)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in that Staff #2 and Staff #3 did not have evidence of TB testing which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/30/2024
	Plan of Correction
1 2 3 4	Per LPM, no TB Test is required due to the facility is located on a LAUSD Elementry School Campus.

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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 3 of 7

Document Has Been Signed on 09/27/2024 11:31 AM - 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: 31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM	FACILITY NUMBER: 191222366
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

101237(a)(b)

101237 Alterations to Existing Buildings or New Facilities (a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s). (b) The Department has the authority to require the licensee to obtain a building inspection by a local building inspector if the Department suspects that a hazard to children's health and safety exists. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation,interview, record review, the licensee did not comply with the section cited above in that the physical location of the facility no longer has a designated classroom and moves from the Library and the Mult Purpose Room #14 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Per Acting Site Supervisor they will establish a permanent location site for the facility on the Elementary School Campus and provide LPA with updated facility documentation by the plan correction due date of 10/25/2024.

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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 4 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: 31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM	FACILITY NUMBER: 191222366
	VISIT DATE: 09/27/2024

NARRATIVE

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Beginning at 06:40 AM, LPA observed the following in the Multi Purpose Room #4. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There are two areas used for each child to store their belongings, large items are placed under a table and smaller items are keep near their chaIrs. Drinking water was readily available and bottled water is provided. The restroom(s) were inspected for safety and sanitation. There were age-appropriate sinks and toilets and there was available water, water temperature was appropriate, toilet paper was provided. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort.

LPA observed a first aid kits located in the Multi Purpose Room #14 and inventoried for necessary supplies. LPA observed a device in the Multi Purpose Room and Library, per FR it is a combination fire and carbon monoxide detector on the ceiling. LPA observed smoke detector via fire alarm. Disaster drill log was available, and the last disaster drill was conducted on 09/19/2024. Per FR, isolation area for sick children is to use an area away from other children in the Multi Purpose Room #14. Hazardous items including poisonous cleaning compounds were stored inaccessible to children.

LPA did observe the kitchen area/ food preparation area, per FR snacks are provided and hot meals are provided by Elementary School.

Beginning at 07:15 AM, LPA toured the outdoor play area and observed playground equipment in safe conditions, free of sharp, loose, or pointed parts, in good repair and age appropriate. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Children have access to the climbing structure located in the play yard and there is a rubber matting to absorb falls. There is adequate shade in the play yard. The children have access to bottled water and water fountains for drinking water during outdoor play. LPA advised that no children shall be left without the supervision at any time. There is no swimming pool or other bodies of water on the premises.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 7 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: 31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM	FACILITY NUMBER: 191222366
	VISIT DATE: 09/27/2024

NARRATIVE

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Beginning at 07: 00 AM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. There were 5 of 5 children’s files missing LIC 701 Physician’s Report. There were 3 of 4 staff records missing Staff Qualification Verification, 2 of 4 missing Immunization and TB Records, 3 of 4 missing LIC 503 Health Screening, 3 of 4 missing Mandated Reporter Training, and 2 of 4 missing LIC 501 Personnel Record. Criminal Record Clearances were reviewed for adults. CPR card expires on 02/2026 for Acting Site Supervisor. Inspection of required forms were discussed.

LPA observed that teacher-child ratios were maintained, and staff names were recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed 0 of 3 children signed in at time of inspection. Personal Rights of children were observed by LPA.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 6 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: 31ST DIST PTSA CREATIVE KIDS- CHATSWORK PARK ELEM	FACILITY NUMBER: 191222366
	VISIT DATE: 09/27/2024

NARRATIVE

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LPA verified with the Plant Manager that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. The Plant Manger would need to obtain a copy of the report from the LAUSD main office.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

As a result of today's visit, the following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Type B Deficiencies were issued for regulation 101220.1 (a), 101700 , 101237 (a)(b), and 1596.8662 (b) (1) and a Plan of Correction is due 10/25/ 2024. Technical Violations were issued for regulation 101215.1(f), 101215.1(m), 101216.1(c)(1), and 101220(b). No Civil Penalty will be assessed today.

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Anthony Jauregui, Acting Site Supervisor including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia Calvillo	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC809 (FAS) - (06/04)

Page: 5 of 7