191609768-4-2-2025-58-CC-AMOS-DFD3YT-20250402184028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191609768
Report Date: 04/02/2025
Date Signed: 04/02/2025 06:40:47 PM

Document Has Been Signed on 04/02/2025 06:40 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:	STAR - FAIRBURN		FACILITY NUMBER:	191609768
ADMINISTRATOR/ DIRECTOR:	VERZOSA, ARNOLD		FACILITY TYPE:	840
ADDRESS:	1403 FAIRBURN AVENUE		TELEPHONE:	(310) 629-7391
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY: 175	TOTAL ENROLLED CHILDREN: 71	CENSUS: 63	DATE:	04/02/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:20 PM
MET WITH:	Director Arnold Verzosa		TIME VISIT/ INSPECTION COMPLETED:	07:00 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 04/02/2025 , Licensing Program Manager (LPM) Emiko Bell and Licensing Program Analyst (LPA) Amelia Morales conducted an unannounced Required- 3 Year inspection for the above program. The program is an after-school program located on the grounds of Fairburn Elementary School. Upon arrival, LPM/LPA walked into the elementary school's main office, where they were directed to the multi-purpose room, located in building 19562, which is down the stairs and to the right from the office, where the STAR program is located. Upon LPM/LPA's arrival, they were greeted by staff James Landon East, who guided LPM/LPA on a tour of the auditorium and who phoned Director Arnold Verzosa, who was off site, and arrived shortly thereafter. The LIC125 Entrance Checklist was provided to help facilitate the inspection. Children's roster was reviewed and is current. After school care is conducted in the Multi-Purpose Room and auditorium. According to the Director, the facility’s hours of operation are from 2:28 PM- 6:00 PM, Monday, Wednesday, Thursday, Friday, and Tuesday from 1:28 PM -6:00 PM. Upon Director Verzosa's arrival, LPA toured the restrooms used by the children, Census was taken at 3:00 PM; there were 63 children with 6 staff. Per the staff East, children ages TK, K and 1st grade are picked up by staff from their classroom, while children in 2nd grade walk themselves to the after school program. Children enrolled in the after school program are signed in by STAR Personnel, parent then sign children out. LPA verified that all adults present in the facility have obtained criminal record clearances and are associated to the facility. LPA observed the following postings in the Multipurpose room: License, the Daily Schedule, Personal Rights, Child Care Center Notification of Parents' Rights Poster, Emergency Disaster Plan and the Child Passenger Safety Law. Snack menus were also posted. The Disaster drill log was available; the last fire drill was conducted on 1/31/2025 and the last earthquake drill was run on 12/12/2024. Page 1 of 3

NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: STAR - FAIRBURN	FACILITY NUMBER: 191609768
	VISIT DATE: 04/02/2025

NARRATIVE

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A walk through of the multi-purpose room and auditorium was conducted; both spaces were found to be clean and free from any potential hazards. Per the Director, rooms #20 and #21 are not currently being used. It was discussed that the Director will submit revised documentation of the changes that will be made.

Furniture was found to be in good repair and age appropriate. There is adequate heating, lighting and ventilation. Drinking water is readily available. Per the Director, children bring their water bottles and use the drinking fountains outside the classroom to refill their water bottles. Isolation area for sick students is located in the multipurpose room. LPM/LPA observed adequate arrangements for isolation and care of ill children.

The bathroom and toileting areas were inspected, there are sufficient toilets and sinks to accommodate the facility’s capacity. Toilets flush properly and toilets and sinks are reachable by the children in care. Director is reminded that students must be escorted to the bathroom at all times and that children enrolled in other after-school programs on campus shall not commingle.

The after school program serves afternoon snack. Per the Director, the dry snacks are picked up weekly from STAR owned warehouse. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. A review of cleaning and food supply storage areas was made.

Per the Director, children utilize most of the playground, except the playground structures (i.e. climbing structures, swings, slides). The Director informed LPM/LPA that they do not use the structures do to the liability. There is adequate shade for the children in care. Fencing around the perimeter of the play area is at least 4 feet high. Playground is free from miscellaneous debris such as tree branches, trash, leaves, etc.

All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. There are no firearms stored on the premises. There are no pools or bodies of water at the facility. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Seven children’s files were reviewed. Inspection of required forms was made and documented on the LIC 857. All seven files were contained the required forms.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

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: STAR - FAIRBURN	FACILITY NUMBER: 191609768
	VISIT DATE: 04/02/2025

NARRATIVE

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LPA also reviewed staff records. The review of staff records was documented on the LIC 859. Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present did have proof against TB, measles, pertussis, and influenza.

Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Per the Director, LAUSD did not provide a copy of the Lead Testing to the STAR Program. However, the Director will obtain a copy of the Lead Testing and email it to LPA Morales.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care
Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Notice of Site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Arnold Verzosa.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/02/2025 06:40 PM - It Cannot Be Edited

Created By: Amelia Morales On 04/02/2025 at 06:00 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: STAR - FAIRBURN	FACILITY NUMBER: 191609768
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 5 out of 5 staff files did not have Pediatric First Aid, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/02/2025
	Plan of Correction
1 2 3 4	Per the Director, staff will enroll to a Pediatric First Aid and take the course within 90 days.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Betty Bell
NAME OF LICENSING PROGRAM MANAGER:

	Amelia Morales
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

LIC809 (FAS) - (06/04)

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