191290477-10-5-2023-58-CC-AMOY-CWBTLN-20231005144948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290477
Report Date: 10/05/2023
Date Signed: 10/05/2023 02:49:57 PM

Document Has Been Signed on 10/05/2023 02:49 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	WASHINGTON CHILDRENS CENTER		FACILITY NUMBER:	191290477
ADMINISTRATOR:	PAULA LAMAR		FACILITY TYPE:	850
ADDRESS:	2207 WEST WINONA		TELEPHONE:	(818) 558-5545
CITY:	BURBANK	STATE: CA	ZIP CODE:	91504
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 21	CENSUS: 15	DATE:	10/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Antonia Pallares, Site Supervisor		TIME COMPLETED:	02:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required 1 year inspection. LPA met with Antonia Pallares, Site Supervisor who guided analyst on tour of the facility. This is a preschool program consisting of one (1) classroom located on the premises of Washington Elementary School (Burbank Unified School District). The facility operates Monday – Friday from 7:00 AM – 5:30 PM. The entrance to the facility is locked and parents enter using a call/buzzer system. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Burbank Unified School District.

LPA toured Classroom Room 1. At 11:40am the children arrived from a walking field trip. LPA observed 15 children and 3 staff. Classroom furniture was in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. Rugs were observed to be flat on the ground to avoid tripping hazards.

Water is made readily available by via water pitcher and cups. Per site supervisor the water comes from the Kitchen faucet. The facility did not completed the lead testing prior to the deadline. The Site Supervisor provided Lead Testing records dated 4/26/17 showing the facility including kitchen faucet had no lead detected. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information and provided PIN 22-21-CCP. Per Site Supervisor, the children will be rpovided bottled water until the Lead Test is completed.

Children have cubbies to store personal belongings. Children are napping at facility. LPA observed cots and napping equipment available. Children bring their own blankets and sheets which were observed to be in bags in individual cubbie space. All bedding is sent home weekly to be washed.

LPA toured the children’s restroom. Restroom is located inside preschool classroom and is used only be preschool children. Restrooms were observed to be sanitary with operable sinks and toilets. ---------------------PAGE 1

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WASHINGTON CHILDRENS CENTER	FACILITY NUMBER: 191290477
	VISIT DATE: 10/05/2023

NARRATIVE

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LPA observed that there are holes in the drywall underneath the sinks, that can pose a potential risk to the safety of children in care.

LPA toured the outdoor play area. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. Shade was observed in the outdoor area. Water pitchers and cups are taken outside to be available for children. Outdoor play area is not shared and is fenced.

LPA reviewed Sign In/Out sheets. All children present were signed in with the date, time and full signature of guardian.

LPA observed required posted documentation in the classroom which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, PUB 269- Child Passenger Restraint System, Licensing Form LIC 613A- Notification of Personal Rights, Daily Schedule and Lunch/Snack Menu.

Facility records were reviewed for 9148- Earthquake Preparedness form, LIC9040- Children's Roster and (LIC) 610- Facility Disaster Plan. Disaster drill was last drill conducted along with the elementary school schedule.

Children’s records were reviewed for Emergency Card with signed medical consent, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. Updating Regional Office information was discussed.

Staff records were reviewed at for approved Pediatric First Aid and CPR certification and current Mandated Reporter Training Certificate. Site Supervisor's file, EMSA approved Pediatric CPR/1st Aid were discussed

Children are provided meals by the school district, children eat inside the classroom or on the play yard. Facility provides Breakfast, Lunch and PM snack. Food is delivered daily. Extra food is stored is discarded daily. All trash cans have tight fitting lids for solid waste. Cleaning supplies are stored separate from the food.

Carbon Monoxide detector observed in classroom. Storage of medication was observed to be in closed cabinet in high shelf inaccessible to children and easily accessible to staff.
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WASHINGTON CHILDRENS CENTER	FACILITY NUMBER: 191290477
	VISIT DATE: 10/05/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretation 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.

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 following deficiencies are cited in accordance to California Code of Regulations Title 22, Division 12, chapter 1.

Exit interview was conducted with Site Supervisor Antonia Pallares and a copy of Appeal Rights (LIC 9058) was discussed and provided

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/05/2023 02:49 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 10/05/2023 at 01:35 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: WASHINGTON CHILDRENS CENTER	FACILITY NUMBER: 191290477
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/05/2023

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 interview, record review, the licensee did not comply with the section cited above in that the facility has not completed the required Lead testing which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/02/2023
	Plan of Correction
1 2 3 4	Per Site Supervisor, the faciltiy will provide bottled water to children and request the lead testing. Proof of correction will be provided to the department by POC due date.

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
1 2 3 4	Based on observation the licensee did not comply with the section cited above in that there are holes in the drywall under the children's bathroom sinks which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/02/2023
	Plan of Correction
1 2 3 4	Per Site Supervisor, a work order has been placed and photo proof of correction will be sent to the department by POC 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:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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