191870904-3-16-2023-54-CC-DGIS-CPYSLW-20230316135902

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870904
Report Date: 03/16/2023
Date Signed: 03/16/2023 01:59:19 PM

Document Has Been Signed on 03/16/2023 01:59 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:	WADSWORTH AVENUE EARLY EDUCATION CENTER		FACILITY NUMBER:	191870904
ADMINISTRATOR:	HUMBERTO BENITEZ		FACILITY TYPE:	850
ADDRESS:	1047 EAST 41ST STREET		TELEPHONE:	(323) 232-0581
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90011
CAPACITY: 111	TOTAL ENROLLED CHILDREN: 111	CENSUS: 76	DATE:	03/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Humberto Benitez, Facility Representative		TIME COMPLETED:	02:15 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 (LPAs) Denise Gibbs and Rosaura Valenzuela conducted an unannounced annual required inspection at the above facility on 3/16/23 at 10:45 AM. LPAs met with Humberto Benitez, Facility Representative (FR) who guided analysts on a tour of the facility. This is a preschool program that operates Monday - Friday from 7:00AM-5:30PM. There were 76 children and 13 staff present when LPAs arrived. Facility is in compliance with license capacity and Title Five ratio guidelines. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. LPAS toured Classrooms #1/PCC, 2, and 3A/3B. All classrooms had furniture in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. Rugs were observed to be flat on the ground to avoid tripping hazards. Operable water fountain was observed in Room#1. Per FR, there are currently no children with medication. Children have cubbies to store personal belongings separate from each other. Children have cots to nap. Bedding is provided by facility and washed weekly by laundry service. There is extra bedding on hand to change as needed. LPA toured the children’s restrooms. LPAs observed three restrooms located behind Room #1. All classrooms use these restrooms. Restrooms were observed to be safe and sanitary with operable sinks and toilets. Facility has completed the required Lead testing with no Action Level Exceedance (ALE) found. Results are posted on the parent board. LPAS toured outdoor play area. LPAs observed two play structures in the yard. Outdoor areas were observed to have age appropriate equipment, toys and material for children. LPA observed required cushioning under climbing structures to absorb fall. Shade was observed throughout the outdoor area. LPAs observed three operable water fountains outdoorS accessible to children. LPAs discussed furniture that was damaged by weather with FR. FR stated that those items (storage shed, desk, and water table) are going to be disposed of next week. ---------------------PAGE 1

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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: WADSWORTH AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870904
	VISIT DATE: 03/16/2023

NARRATIVE

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LPAs observed required posted documentation in the main entrance hallway and on the outside bulletin board, which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights and Lunch/Snack Menu. All items were observed.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedules and Disaster drill log, last drill conducted on 2/3/23. All items were observed.

LPAs toured the kitchen on site. Facility provides AM snack, PM snack and lunch. Food is not cooked at the facility. Prepackaged food is brought from the neighboring elementary school. Extra food is discarded. Food storage area was observed to be clean, free of litter, insects and rodents. Trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food. Carbon monoxide detector is located in Room #1 outside of the kitchen. Carbon monoxide detector was tested and operable.

LPAs reviewed Sign In/Out sheets are located in the main entrance. All children present were signed in with the date and full signature of the child's guardian. LPAs observed that 17 children are missing sign in times.

Children’s records were reviewed for Emergency Card with consent for medical treatment, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All documents were observed.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, 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, Transcripts or Permit and current Mandated Reporter Training Certificate. Three staff are missing immunization records.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

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: WADSWORTH AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870904
	VISIT DATE: 03/16/2023

NARRATIVE

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Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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/process.

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

Exit interview conducted and report was reviewed with the Facility Representative Humberto Benitez.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/16/2023 01:59 PM - It Cannot Be Edited

Created By: Denise Gibbs On 03/16/2023 at 01:24 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: WADSWORTH AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870904
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. 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 3 OUT 5 STAFF FILES which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	FR STATES THAT HE WILL ASK THE STAFF FOR IMMUNIZATION RECORDS AND HAVE THEM SUBMIT TO HIM AS SOON AS POSSIBLE. ONCE HE RECEIVES THE RECORDS HE WILL EMAIL TO LPA BY POC DATE 4/14/23

Type B

Section Cited

CCR

101229.1(a)(1)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. 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.17 OUT OF 76 SIGNATURES ARE MISSING THE DATE, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/14/2023
	Plan of Correction
1 2 3 4	FR STATES THAT THE IS HAVING A PARENT MEETING, HE WILL BRING UP THE ISSUE REGARDING TIMES WITH THE PARENTS. HE WILL POST A DOCUMENT NEXT TO THE SIGN IN FOLDERS REMINDING PARENTS ABOUT THE TIME. FR WILL EMAIL LPA COMPLETED WEEK SIGN IN SHEET WILL ALL TIMES DOCUMENTED BY POC DATE 4/14/23.

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:

Denise Gibbs

LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC809 (FAS) - (06/04)

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