191606358-9-27-2022-30-CC-JLAO-CJNSWW-20220927141502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191606358
Report Date: 09/26/2022
Date Signed: 09/27/2022 02:17:09 PM

Document Has Been Signed on 09/27/2022 02:17 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER		FACILITY NUMBER:	191606358
ADMINISTRATOR:	KAE CONNORS		FACILITY TYPE:	850
ADDRESS:	2114 PONTIUS AVENUE		TELEPHONE:	(310) 445-8993
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90025
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 90	CENSUS: 34	DATE:	09/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Summer Saito, Health and Safety Director		TIME COMPLETED:	01:30 PM

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 9/26/2022 Licensing Program Analyst (LPA) Judy Laureano conducted unannounced Annual Required Inspection at 2114 Pontius Avenue, Los Angeles, CA 90025. LPA met with Health and Safety Director Summer Saito. The current facility’s director was not on site for today’s inspection. LPA toured the facility indoors and outdoors and observed 34 children and 10 staff member providing care and supervision. Facility currently operates Monday through Friday 7:45 a.m. to 6:15 p.m. LPAs toured and inspected the facility in accordance with the facility sketch. Teacher/child ratios are maintained, and adequate supervision is being provided. The following was observed: Yellow Room- 5 children and 2 staff members. Blue Room – 5 children and 3 staff members. Castle Room- 13 children and 3 staff members. Boat Room- 11 children and 2 staff members. 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 and cleaning solutions are kept in each classroom in a locked cabinet. Cleaning crew comes every evening and once a month a separate vendor comes to deep clean the bathrooms. First Aid Kit bags were observed in each classroom and every yard, outdoor space, has one. Medication is stored in director's office and only Epi Pens are stored in the classroom away children. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER	FACILITY NUMBER: 191606358
	VISIT DATE: 09/26/2022

NARRATIVE

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The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA observed different shaded area in the outdoor space with age appropriate play equipment and toys. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls.

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.

Facility requires families to bring in their lunch. Facility only provides morning and afternoon snack, facility representative confirmed that they are currently following COVID 19 recommendations and having most snacks individually wrapped. 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, filter water is provided via water pitcher to children in care and children bring in their refillable bottle.

The facility is free of flies, insects and rodents, pest control services comes once a month. Facility will also contact pest control services if needed before their monthly scheduled time.

There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort.

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.
Capacity and limitations as specified on the license are being maintained.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER	FACILITY NUMBER: 191606358
	VISIT DATE: 09/26/2022

NARRATIVE

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At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. Facility provides biannual training to all staff on site. LPA was not able to review staff’s file due to director being out and facility not having access to the locked cabinet. LPA will contact director to schedule an appointment to review all staff’s files. LPA provided facility representative with a copy of LIC311A and LIC 125 to use as a guide to audit files and program.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. Facility requires families to use one central location for signing in and out to ensure all families complete the daily health check.

All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care.
LPAs reviewed 6 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.

Menus are posted in every classroom and are provided a copy to parents via online. Facility only provides morning and afternoon snack, children bring in their own lunch. LPA’s discussed with discussed the importance of maintaining menus for at least 30 days and noting any changes and/or substitution made.

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/inspection-process.

Facility representative, Summer Saito, 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER	FACILITY NUMBER: 191606358
	VISIT DATE: 09/26/2022

NARRATIVE

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Incidental Medical Services (IMS) currently being provided. Licensee is aware that an IMS
plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPAs and facility representative discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee facility representative, Summer Saito.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

LIC809 (FAS) - (06/04)

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