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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600639
Report Date: 11/17/2022
Date Signed: 11/17/2022 02:33:45 PM

Document Has Been Signed on 11/17/2022 02:33 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:ST MATTHEWS PARISH SCHOOLFACILITY NUMBER:
191600639
ADMINISTRATOR:DANA BERLINFACILITY TYPE:
850
ADDRESS:1031 BIENVENEDA AVETELEPHONE:
(310) 454-1359
CITY:PACIFIC PALISADESSTATE: CAZIP CODE:
90272
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 52DATE:
11/17/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:Director Kristine VardanyanTIME COMPLETED:
02:45 PM
NARRATIVE
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On 11/17/22 at 8:41 AM, Licensing Program Analyst (LPA) Antonio Almanza, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director Kristine Vardanyan and Administrator Juana Ochoa, toured the facility indoors and outdoors. Days and hours of operation are Monday – Friday 7:50 AM – 3:00 PM. Facility phone number is 310-454-1359. During today’s visit there are 48 children and 14 Adults providing care and supervision.

The facility is located on the premises of the St Mathews Episcopal Church. Within the premises of the church there is St Mathews Parish School (k-8). There is a parking lot off Bienvenida Ave where visitors can park. On the right-hand side of the parking lot there are stairs that lead up into a large grass field (Meadow). The pathway on the right-hand side leads up to the preschool. There is a security guard shack with security in front of the preschool and a private road that is used by parents and authorized facility personnel. The private road goes around 3 sides of the preschool. The facility office is the first glass door located on the walkway passing the guard shack. There are wooden, concrete and iron fencing around the perimeter of the facility.

The main playground in the facility is located on the south side of the premises. This playground has a hill side along the South east perimeter and there are climbing structures and apparatus build into the hillside for children to climb and play in. There is a walk way at the top of the hillside has 4x4 pillars and roping on the side of the hill. There is road on the other side of the walkway. There is a horizontal 2x6 wood fence. The fencing is horizontal and there are gaps between 7 inches and up to 1 foot 5 inches on the horizontal fencing around the facilities playgrounds next to the road. The fence does not measure 4 feet in height. The Facility is reporting that the road is used by parents during pick up and drop off, and approved employees of the premises.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/17/2022 02:33 PM - It Cannot Be Edited


Created By: Antonio Almanza On 11/17/2022 at 01:25 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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(c)(1)
Teacher Qualifications and Duties
(c) To be a fully qualified teacher, a teacher shall have one of the following: (1) Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in Staff 1 Does not have ECU units and was supervising 14 children, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2022
Plan of Correction
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Provide written memo to staff regarding ratios, teacher qualifications and duties and provide LPA memo by 11/30/22 with Staff signatures.
Type B
Section Cited
CCR
101161(a)
Limitations on Capacity and Ambulatory Status
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above, the facility is using the Meadow, Library, Music Classroom and Falcons classroom that are not part of the Licensed Child Care Center, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/18/2022
Plan of Correction
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The facility will cease the use of this areas and submit a waiver request if they wish to continue to use Meadow, Library, Music Classroom. The facility will submit an application for the addition of the Falcons Classroom.
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
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


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Document Has Been Signed on 11/17/2022 02:33 PM - It Cannot Be Edited


Created By: Antonio Almanza On 11/17/2022 at 01:25 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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.3(a)
Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that on 10/06/22 staff 1 was supervising 14 children in the meadow, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2022
Plan of Correction
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Provide written memo for staff regarding ratios, teacher qualifications and duties.
Type B
Section Cited
CCR
101227(a)(14)
Food Service
(14) All persons engaged in food preparation and service shall observe personal hygiene and food-service
sanitation practices that protect food from contamination.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that LPA observed that staff did not clean and disinfect tables prior to children eating lunch, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2022
Plan of Correction
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Facility will provide Staff with memo on proper cleaning and disinfecting of table prior to children eating and have staff sign off that they received memo.
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
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


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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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639
VISIT DATE: 11/17/2022
NARRATIVE
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There is another small playground located on North East corner of the facility that has a wooden fence composed of vertical 6x2s with gaps large enough for children to go through and on to the road. In the northern corner of this playground there is a light post next to the fence and the fence has an open space at the bottom of this section that measures 1 foot 5 inches from the ground up to the first vertical 6x2. The fence does not measure 4 feet in height.

The facility fencing around the playgrounds are under 4 feet in height in some areas and do not meet the minimum requirements of Title 22 Regulations.

During the visit, LPA observed Classrooms 101, 102, 104, 105, Little Falcons classroom, office and Staff Lounge located within the perimeter of the preschool enclosure. Rooms 101 and 102 are located on the North/East section of the preschool, share a bathroom and have access to an enclosed playground that does not have wooden fencing. Rooms 104, 105 and Falcons are in the center of the facility next to the office; have their own restroom inside the classroom; and have access to the Hillside Playground.

The facility Sketch on file does not give a clear representation of the lay out of the facility and dose not show the addition of the Falcons classroom. There are no reports on file approving the Falcons classroom, that used to be the the facility office. Facility is reporting that the Falcons classroom was added during Covid. LPA has notified the Director that they must cease the use of the Falcons room until it is approved by the Department.

On 10/21/2020, the department conducted a site visit for the purpose of increasing capacity by 37 children for a total of 105 preschool children. According to report, “the center plans to accomplish the requested increase by adding 3 additional classroom (201,202 and 203) and a separate outdoor activity space.” The facility has clarified that these three classrooms are located in the building behind room 102, across the loop around, outside of the preschool compound.

The facility is not currently operating rooms 201,202 and 203. This rooms are being used by the St. Mathew's Parish School (k-8). The facility Director and Administrator are reporting that the facility will submit an application to add the Falcons classroom, remove rooms 201,202, and 203 and decrease capacity. During today visit LPA did not observe facility staff clean and disinfect table prior to children eating lunch.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639
VISIT DATE: 11/17/2022
NARRATIVE
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LPA observed Fire Extinguishers (serviced 08/15/22), operating Smoke and Carbon Monoxide detectors where observed. The facility provides snacks and parents provide meals for children in care. Parents have option of ordering meals from an outside vendor. Medications are stored in Nurses office located in the administrative building. The isolation room for children who become ill while in care is located in the Nurses office and isolation restroom is also in the Nurses office.

On 10/06/22 at 9:34 AM, during Annual Inspection, LPA observed Staff 1 supervising 14 children in the Meadow. Staff 1 does not have ECE units and the Meadow is not an approved area for the Licensed Child care Center. During todays visit LPA observed 14 children and 3 adults in the Music classroom located across from the Loop Road. This Music classroom is not an approved classroom for the Child Care Center or inside the compound of the Child Care Center.



There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects, and rodents.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639
VISIT DATE: 11/17/2022
NARRATIVE
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The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files for health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

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.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, 5 Type B deficiencies are being cited (see next page, 809 D) and 2 Technical Violations. Licensee was provided a copy of their appeal rights.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted, a copy of this report was reviewed and provided to the facility representative Director Dr. Kristine Vardanyan.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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Document Has Been Signed on 11/17/2022 02:33 PM - It Cannot Be Edited


Created By: Antonio Almanza On 11/17/2022 at 01:42 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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(g)
101238.2(g) Outdoor Activity Space - The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above in that the fencing around some areas of the perimeter of the facility do not meet the minimum requirements of Title 22 Regulations, which possesses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/16/2022
Plan of Correction
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Facility will have the fencing around the perimeter of the facility meet the minimum requirements of Title 22 Regulations, Division 12, Chapter 1, section 101238.2.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


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