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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600356
Report Date: 11/04/2022
Date Signed: 11/04/2022 11:20:06 AM

Document Has Been Signed on 11/04/2022 11:20 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WHITEWOOD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191600356
ADMINISTRATOR:LISA PAIONIFACILITY TYPE:
850
ADDRESS:5511 WHITEWOOD AVETELEPHONE:
(562) 461-2227
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 136TOTAL ENROLLED CHILDREN: 57CENSUS: 0DATE:
11/04/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Sabriya Bayati PedrettiTIME COMPLETED:
11:30 AM
NARRATIVE
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On November 4, 2022 at 8:30 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the Bellflower Unified School District (BUSD) Early Childhood Education (ECE) Office located at 9301 Flower St., Bellflower, CA 90706 and met with Director, Sabriya Bayati Pedretti. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The purpose of the inspection was to conduct the Case Management - Annual Continuation inspection for the facility noted above and complete the personnel record reviews for the staff that were present at the facility on October 20, 2022 at 11:10 am (S1, S2, S3, and S4). LPA also conducted a record review for the Site Director, Sabriya Bayati Pedretti. The names of staff whose records were reviewed were documented.

Based on the record reviews, staff (S1) did not have an immunization record for measles, pertussis, and influenza or documentation of exemption, Health Screening Report (LIC 503), and certificate of completion for the Mandated Reporter (AB 1207) available for review. LPA also found that the Director did not have the Mandated Reporter (AB 1207) certificate of completion, Preventative Health and Safety Practices (EMSA-approved) certificate of completion, LIC 503, and immunization record for measles or documentation of exemption available for review.

Director was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

Deficiencies were cited during today's inspection (refer to deficiency pages).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Sabriya Bayati Pedretti.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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Document Has Been Signed on 11/04/2022 11:20 AM - It Cannot Be Edited


Created By: Monique Ayala On 11/04/2022 at 10:49 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WHITEWOOD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191600356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022

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
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Based on record review, the licensee did not comply with the section cited above in 2 personnel records (Director and staff (S1)) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2022
Plan of Correction
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Director will submit the immunization records for Director (measles) and staff (S1) (measles, pertussis, and influenza) to LPA via e-mail by December 5, 2022.
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 2 personnel records (Director and staff (S1)) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2022
Plan of Correction
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Director will submit proof of completion for the mandated reporter (AB 1207) training for the Director and staff (S1) to LPA via e-mail by December 5, 2022.
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:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 11/04/2022 11:20 AM - It Cannot Be Edited


Created By: Monique Ayala On 11/04/2022 at 10:49 AM
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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WHITEWOOD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191600356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(m)
Child Care Center Director Qualifications and Duties
(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2022
Plan of Correction
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Director will submit proof of completion for the Preventative Health and Safety Practices (EMSA-approved) to LPA via e-mail by December 5, 2022.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

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 2 personnel records (Director and staff (S1)) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2022
Plan of Correction
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Director will submit the completed Health Screening Report (LIC 503) for the Director and staff (S1) to LPA via e-mail by December 5, 2022.
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:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
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