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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870577
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:10:44 PM

Document Has Been Signed on 08/11/2023 04:10 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLOWBROOK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191870577
ADMINISTRATOR:SONIA LOVEFACILITY TYPE:
850
ADDRESS:12829 SO. JARVIS AVE.TELEPHONE:
(310) 352-4486
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 30DATE:
08/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lucy BryantTIME COMPLETED:
04:25 PM
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Licensing Program Analysts (LPAs) Angelica Wallin and Warren Birks conducted an unannounced annual inspection on 08/11/2023 at 12:30 PM. LPAs met with site supervisor Lucy Bryant, who guided analysts on a tour of the facility. This facility consists of 4 classrooms. The operating hours for this facility is Monday through Friday from 7:30 AM to 5:00 PM. This facility has a toddler component attached to the preschool with physically separate classroom and shared playground.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Room 1A: 1 staff with 8 preschoolers; Room 1B: 1 staff, with 7 preschoolers; and Room 2: 4 staff with 7 preschoolers. The toddler room had 4 staff and 7 toddlers. The facility was observed to be within the license capacity and limitations. The following was observed during the tour of the facility:

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are washed by the facility every Friday after school and or Monday morning. LPAs observed napping cots are located in classroom in a cabinet under shelving. Age appropriate sinks and toilets were inspected for availability and good repair in all classrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms.



Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Carbon monoxide detectors were observed and are operable. 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 moveable bins 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.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLOWBROOK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870577
VISIT DATE: 08/11/2023
NARRATIVE
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLOWBROOK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870577
VISIT DATE: 08/11/2023
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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. There is adequate shade in the play yard. LPAs advised that no children shall be left without the supervision of a teacher at any time. 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.

Children’s records were reviewed for Admission Agreement, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 613-Personal Rights, LIC 702-Health History, and LIC 701 Physicians Report, and Immunization Records.

Staff records were reviewed for Education, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, LIC 503- Health Screening, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Facility used third-party Child-Care Careers for clearance of substitute teachers. Child care career records were not maintained in legible manner. The facility was cited for criminal record clearance maintenance. Facility will fax over Child Care Careers documents.



Food is prepared at the facility. The facility provides a PM snack. Per site supervisor, water is provided via water pitchers in the classroom. Menus are posted outside each classroom one week in advance. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair.

During the inspection, LPAs inquired with site supervisor regarding lead testing. Per site supervisor, the water used for drinking or cooking has tested for lead and results are posted in facility.

First Aid supplies were observed in the classroom. According to site supervisor, facility does not currently administer any medication at this time. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in facility nurse room.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLOWBROOK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870577
VISIT DATE: 08/11/2023
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Site supervisor 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.

This facility does not currently provide Incidental Medical Services – IMS. Site supervisor showed LPAs current lock box storage medications if needed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

LPAs advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.



The deficiency listed on the following page was observed by the LPAs and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809 D for the deficiency that is being cited and need to be cleared to protect the children’s health & safety.

Exit interview conducted with the site supervisor, Lucy Bryant.

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

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/tion-process.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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Document Has Been Signed on 08/11/2023 04:10 PM - It Cannot Be Edited


Created By: Angelica Wallin On 08/11/2023 at 03:37 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: WILLOWBROOK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870577

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(j)
Criminal Record Clearance
(j) The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of volunteers that require fingerprinting.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in: Child care career records were not maintained in legiible manner which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Facility will fax over Child Care Careers documents.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Angelica Wallin
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023


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