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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191805526
Report Date: 09/15/2025
Date Signed: 09/15/2025 03:15:47 PM

Document Has Been Signed on 09/15/2025 03:15 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:BURBANK BLVD. ELEMENTARY SCHOOL(ST. PRESCHOOL)FACILITY NUMBER:
191805526
ADMINISTRATOR/
DIRECTOR:		PENA, CLARAFACILITY TYPE:
850
ADDRESS:12215 ALBERS ST., RM.1 & 2TELEPHONE:
(818) 763-6497
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91607
CAPACITY: 45TOTAL ENROLLED CHILDREN: 16CENSUS: 13DATE:
09/15/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Cindy Gutierrez, Principal. TIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Amelia Morales conducted an unannounced annual inspection to the above facility on 09/15/2025. LPA arrived at the facility at 8:45 AM, identified self and met with Cindy Gutierrez, Principal, who guided analyst on a tour of the facility. LPA provided Principal with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is a preschool program which consists of two classrooms: RM 1 and RM 2. However, the facility is only using RM 1 for the program and presently RM 2 is being used by Special Ed. Program. Principal Gutierrez informed LPA Morales that the Preschool program hours of operation are from Monday to Friday from 8:00AM to 2:23PM, however the main office hours of operation are Monday to Friday from 7:00 AM to 4:30 PM.

All areas identified on the Facility Sketch were inspected. There were 13 children and 3 staff present when LPA arrived. The facility was observed to be within the license capacity and limitations. This facility is funded by the California Department of Education and operates under Title 5 staffing ratios. Criminal record clearance was not reviewed. However, per conditions of employment with the Los Angeles Unified School District, all individuals present have obtained a criminal record clearance or criminal record exemption.

The following was observed during the tour of the facility:

Furniture and equipment were inspected for age appropriateness and good repair. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. Telephone service, heating, lighting and ventilation were evaluated.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2025
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: BURBANK BLVD. ELEMENTARY SCHOOL(ST. PRESCHOOL)
FACILITY NUMBER: 191805526
VISIT DATE: 09/15/2025
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Children in RM 1, RM 2, have their own cubby to store their belongings. LPA did not observe children belongs touching. LPA observed (mats) napping equipment stored in cabinets in each classroom. Linens are washed weekly by school district. Age-appropriate sinks and toilets were inspected for availability and good repair in the restrooms. Each classroom also has an additional sink for hand washing. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Per Principal, children bring their own water bottle daily and filtered water stations are available for children who need water refills.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Principal states that there are no poisons. Carbon monoxide detectors were observed and are operable. Disaster drill log was available, last drill was conducted on 8/21/2025.

Menus are posted one month in advance online, parent are able to access this on the LAUSD District website, as well as the school website. LPA recommended facility to have a copy posted, where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Per Principal, snacks are provided by parents and the facility provides breakfast and lunch. Food is prepared in the main elementary cafeteria next door to the facility. Meals are brought to the facility daily.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including movable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.

Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. LPA advised that no children shall be left without the supervision of a teacher at any time.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: BURBANK BLVD. ELEMENTARY SCHOOL(ST. PRESCHOOL)
FACILITY NUMBER: 191805526
VISIT DATE: 09/15/2025
NARRATIVE
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Per Principal, there are no firearms stored on the premises. LPA did not observe pools or bodies of water at the facility.

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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA reviewed staff records. The review of Staff records was documented on the LIC 859. here is at least one person trained in CPR and Pediatric First Aid present during this inspection. 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.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857. Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children presents were signed in.

First Aid supplies were observed in the classroom in a cabinet. The facility was observed to be equipped with an isolation area for any child who becomes ill, children are taken to the nurse's office for isolation.



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/.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
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: BURBANK BLVD. ELEMENTARY SCHOOL(ST. PRESCHOOL)
FACILITY NUMBER: 191805526
VISIT DATE: 09/15/2025
NARRATIVE
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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.

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

There were no deficiencies cited during today’s inspection

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Cindy Gutierrez, Principal.

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NAME OF LICENSING PROGRAM MANAGER: Betty Bell
NAME OF LICENSING PROGRAM ANALYST: Amelia Morales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
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