191802294-3-6-2024-54-CC-CKAM-D35345-20240306165433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802294
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:54:53 PM

Document Has Been Signed on 03/06/2024 04:54 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	LUMBINI CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	191802294
ADMINISTRATOR:	NICHO, LESLIE		FACILITY TYPE:	850
ADDRESS:	505 EAST THIRD STREET		TELEPHONE:	(213) 680-2976
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90013
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 13	DATE:	03/06/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Leslie Nicho		TIME COMPLETED:	05:20 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	Licensing Program Analysts (LPA)s, Katrina Chicote and Claudia Kam made an unannounced required visit at above licensed facility. At 1:45 PM, LPA met with Leslie Nicho and was taken on a guided tour of both indoors and outdoors of the facility. LPA observed proper care and supervision and ratio. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number. LPA observed sign in and sign out sheets. This is a preschool with affidavit for kindergarten program facility, the hours of operation are 7:30 am – 6:00 pm Monday - Friday. Facility is currently licensed for a capacity of 60. At the initial start of the site visit, there is a total census of 13 children and a total census of 3 teachers present. The facility is made up of 3 classrooms. Room 1: had 6 kids and 1 staff, Room 2: had 5 kids and 1 staff, Room 3: 2 kids and 1 staff at time of inspection. LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule. Children and staff records were reviewed. LPA discussed CPR and First Aid Certification for all center staff. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Children napping equipment met the requirement regulation, bedding is supplied by the clients. Storage for children's belongings, bathrooms facilities, and isolation areas were inspected. Age-appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, and safety and sanitation. 2 bathrooms with 3 toilets each and a large shared sink observed at time of inspection. LPAs observed classrooms equipped with with toys, learning supplies and art supplies, books, and other appropriate toys to be clean and free of hazards at time of inspection. LPAs observed carpets and age-appropriate tables and chairs in each classroom. LPAs observed first aid kept in classrooms. Page 1 of 4

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
	VISIT DATE: 03/06/2024

NARRATIVE

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Children drinking water was observed. Center was reviewed for lead compliance. Childcare center has completed testing and is in the process of remediating. 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 childcare 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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records was made. Fire & Earthquake drill observed conducted with last done Feb. 2024 at time of inspection. Snack/lunch menus were reviewed. Facility provides lunch, and snacks. All food items are prepared on site by a volunteer. Food and snack items are properly stored. Food preparation area was toured for safety, cleanliness, and proper storage.
Carbon monoxide detectors and smoke detectors are present in the facility and were tested at time of inspection. Fire extinguishers have been serviced on 6/22/23. Hazardous items including poisonous cleaning compounds were stored inaccessible area to children.

At 1:45 PM, LPAs observed outdoor play area which consists of a play structure with cushioning material underneath, 3 play houses, 2 play kitchens and age appropriate tables. Outdoor equipment was inspected for safety, cushioning material, good repair, and age appropriateness. LPAs observed required shade and fencing were inspected. LPAs advised Director that the children need to be always within the direct care and visual supervision by the teachers. Per Director, the children have access to drinking water via water fountains, however per Director children bring personal water bottles daily. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed at time of inspection.

Teacher child ratios were observed, and staff names recorded. Care and supervision evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPAs at time of inspection.

LPA reviewed with facility representative the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires on 10/20/21 for Staff Member. Inspection of required forms made.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
	VISIT DATE: 03/06/2024

NARRATIVE

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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/.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVESCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.
The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

These forms may also be downloaded from our website: www.ccld.ca.gov

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC809 (FAS) - (06/04)

Page: 4 of 8

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
	VISIT DATE: 03/06/2024

NARRATIVE

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Based on this information the following deficiencies on the LIC 809 D are being cited today 3/6/24.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative.

On 3/6/24 at 5:00 PM, exit interview was conducted with Director, Leslie Nicho. A copy of this report was given, and appeal rights were issued and discussed.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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 platforms.

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.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC809 (FAS) - (06/04)

Page: 3 of 8

Document Has Been Signed on 03/06/2024 04:54 PM - It Cannot Be Edited

Created By: Claudia Kam On 03/06/2024 at 03:47 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2024

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	Upon file review of employees files there are 3 of 3 with with exipred CPR 10/21/21.
	POC Due Date: 04/08/2024
	Plan of Correction
1 2 3 4	Director has declared that she and her staff will be completing the needed training for CPR and mandated reporter by 4/8/24 and will be emailing LPA verification for all staff.

Type B

Section Cited

HSC

1596.8662(b)(1)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review 3 of 3 staff files reviewed were incomplete due to expired mandated reporter and CPR training as per regulation for health and safety
	POC Due Date: 04/08/2024
	Plan of Correction
1 2 3 4	Director has declared that she and her staff will be completing the needed training for CPR and mandated reporter by 4/8/24 and will be emailing LPA verification for all staff.

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:

Denise Gibbs

LICENSING EVALUATOR NAME:

Claudia Kam

LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC809 (FAS) - (06/04)

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