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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600639
Report Date: 05/25/2023
Date Signed: 05/25/2023 03:13:56 PM

Document Has Been Signed on 05/25/2023 03:13 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: DATE:
05/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:TIME COMPLETED:
03:30 PM
NARRATIVE
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On 05/25/23 at 8:35 AM, Licensing Program Analysts (LPAs) Maria Rendon and Antonio Almanza conducted an announce decrease in capacity case management visit at the facility. LPAs met with with Dr. Kristine Vardanyan, Director, who guided LPAs on a tour of the facility indoors and out.

During today’s visit there are 60 children and 12 staff in the facility. The facility has a pending application for 80 pre-school children, ages 2 years to entry into school. The child care center will operate Monday – Friday, 7:50 AM – to 3:30 PM. The fire clearance was approved on 04/25/23.

LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 5 classrooms. Children will have access to 10 sinks and 10 toilets. The facility is removing Rooms 201, 202, and 203 that are located across the loop road on the west side of the facility.

INDOOR AND OUTDOOR MEASUREMENTS



ROOM IDENTIFICATIONLENGTHWIDTH
AREA
ENCUMBERED
SPACE
Little Falcons
22.25
18
400.50
0.00
400.50
Room 104
27.75
21.33
591.91
591.91
Room 105
27.75
21.33
591.91
591.91
Room 101
27.05
34.67
937.82
189.28
748.54
Room 102
27.05
34.67
937.82
189.28
748.54

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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: ST MATTHEWS PARISH SCHOOL
FACILITY NUMBER: 191600639
VISIT DATE: 05/25/2023
NARRATIVE
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OUTDOOR PLAY SPACE
AREA IDENTIFICATIONLENGTHWIDTH
AREA
ENCUMBERED
SPACE
1 Lower Preschool yard
77.05
44.17
3403.30
384.36
3018.94
2 Upper Preschool yard
35.75
51.83
1852.92
47.22
1805.70
3 Preschool yard
112
59.58
6672.96
80.00
6592.96
Hillside playground
91.58
27
2472.66
2472.66

CAPACITY BASED ON INDOOR SPACE: 88
CAPACITY BASED ON OUTDOOR SPACE: 185
CAPACITY BASED ON SINKS:150
MAXIMUM CAPACITY: 88

Indoor/Children’s Area:

All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard were observed. The child care center was observed be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Floors of all rooms have a surface that is safe and clean. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to meet the needs of the children. All play equipment and materials used by children were observed to be age-appropriate. The licensee shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding. All materials and surfaces accessible to children, including toys, shall be free of toxic substances.

Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area. The licensee shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. Page 2

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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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: 05/25/2023
NARRATIVE
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 Fireplaces and open-faced heaters shall be made inaccessible to children to ensure children's safety. All window screens shall be in good repair and free of insects, dirt and debris.

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. Storage areas for poisons shall be locked. The licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children: A current edition of a first-aid manual, sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution.

A center shall be equipped to isolate and care for any child who becomes ill during the day. The isolation area shall be located to afford easy supervision of children by center staff. The isolation area shall be equipped with a mat, cot, couch or bed for each ill child. The isolation area shall not be located in the kitchen area or the general-use toilet area.

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility. All child care centers shall have working telephone service on the premises.

In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following:

The licensee shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.

Smoking is prohibited on the premises of a child care center as specified in Health and Safety Code Section 1596.795(b).

There shall be at least 35 square feet of indoor activity space per child based on the total licensed capacity. Based on the total licensed capacity, one toilet and one hand washing fixture shall be maintained for every 15 children, or fraction thereof.

Napping:


Cots used for napping shall be maintained in a safe condition. Page 3
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: 05/25/2023
NARRATIVE
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Constructed of foam at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Marked or colored so that the sleeping side can be distinguished from the floor side. Wiped with a detergent/disinfectant weekly or when soiled or wet.

Maintained in a safe condition with no exposed foam. Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.

The licensee shall provide a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.

Restrooms:


All toilets, handwashing and bathing facilities shall be maintained in safe and sanitary operating condition. Additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.
Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

Notwithstanding (e) and (e)(1) above, handwashing fixtures shall not be required to deliver hot water.

There shall be one toilet and one handwashing fixture, separate from and in addition to the number of toilets and handwashing fixtures required in (h) above, designated for use by children who are ill, for use by staff, and for emergency use. This toilet and handwashing fixture shall be conveniently located in relation to the isolation area.

Outdoor:


Provide a shaded rest area for the children. Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.
Sandboxes shall be inspected daily and kept free of hazardous foreign materials.

Page 4

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 4 of 9
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: 05/25/2023
NARRATIVE
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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. The fence along the East Side of does not meet the minimum requirement and measures less than four feet.

The main preschool playground has a hill side along the southside and there is playground built into it. There is climbing structures and apparatus build into the hillside for children to climb and play in. There are pillars and bowlders on the hillside for children to climb up. There are no safety nets or retainers to hold children from falling if they slip while on the hillside.

Director is reporting that she is unaware if the the Hillside was reported to the department in writing. Director does not know when the hills side playground was constructed.

Director is reporting that she started working at the facility on June 1, 20222 and children have been using the hillside playground since she has been working at the facility.

Director is reporting that the Fire Inspector inspected the entire facility on 04/25/23 and did walk around the hillside play area but did not mention any concerns.

Any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. This shall include, but not be limited to, incinerators, air- conditioning equipment, water heaters, and fuse boxes.

There shall be at least 75 square feet per child of outdoor activity space based on the total licensed capacity.

Health Related Services:

Medications shall be kept in a safe place inaccessible to children. A refrigerator shall be used to store any medication that requires refrigeration.

The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 5 of 9
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: 05/25/2023
NARRATIVE
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Food Service:

All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.

All foods or beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (72 degrees C) or less.

Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored.

Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

All kitchen, food-preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin.

The food-preparation area shall not be used for: Children's play activities unless such activities are part of a supervised food-education program. Full-day programs shall offer a midmorning and a midafternoon snack.

Full-day programs shall ensure that each child has a lunch. Half-day programs shall offer a midmorning or midafternoon snack.

Postings:

The license shall be posted in a prominent, publicly accessible location in the center.

The center shall post a copy of the LIC 613A (9/96) in a prominent, publicly accessible area in the center.

The licensee shall post the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster in a prominent, publicly accessible area in the child care center at all times.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: 05/25/2023
NARRATIVE
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Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

The licensee shall post signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5 FORM: LIC 610

Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available. Contingency plans for action during fires, floods and earthquakes including, but not limited to, the following: FORM: LIC 9148.

The licensee shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

The following items were discussed:

This facility does not provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

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SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: 05/25/2023
NARRATIVE
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


Director was reminded that the El Segundo Regional Office shall be notified prior to making changes to the facility.

One Type B violation is being issued during todays visit,

The following corrections are needed before a decrease in capacity will be considered. Corrections are due by 06/23/23:

· Facility will make corrections to the fence in the main preschool yard to meet minimum requirements per Title 22 Regulations.

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 Dr. Kristine Vardanyan, Director.

Page 8

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 8 of 9
Document Has Been Signed on 05/25/2023 03:13 PM - It Cannot Be Edited


Created By: Antonio Almanza On 05/25/2023 at 01:57 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: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/23/2023
Section Cited
CCR
101238.2(g)

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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:
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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.(g)
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Based on observation the licensee did not comply with the section cited above in that the fencing along the eastside of the pre-k plyaground does not meet the minimum requirements of Title 22 Regulations, which possesses a potential health, safety or personal rights risk to persons in care.
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Facility will complete corections by 06/23/23.

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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:Betty Bell
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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