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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402063
Report Date: 02/07/2023
Date Signed: 02/07/2023 11:03:31 AM

Document Has Been Signed on 02/07/2023 11:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WEIGAND ELEMENTARY SCHOOL ROOM 6FACILITY NUMBER:
197402063
ADMINISTRATOR:TAMARA HONEGANFACILITY TYPE:
850
ADDRESS:10401 WEIGAND AVENUETELEPHONE:
(323) 567-9606
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Tamara Honegan, Facility RepresentativeTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 2/7/23 at 8:50 AM. LPA met with Loed Lacayo, Facility Representative (FR) who guided analysts on a tour of the facility.

There were 19 children and three staff present when LPA arrived. Facility is on the campus of Weigand Elementary School and operates an AM and PM program, 8AM to 11AM and 12PM to 3PM. 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.

LPA toured Classroom 6. Classroom furniture was in good condition, free of loose, sharp and/or pointed parts. LPA observed the rug in the classroom to have dark spots throughout the carpet. Per FR carpet is cleaned during Winter, Spring and Summer Breaks. Water is made readily available by via water bottles labeled with the children's names. LPA observed extra water bottles in storage. Required water lead testing has been completed and drinking fountains were removed both indoor and outdoors. Children have hooks to store personal belongings. While children were outside playing, LPA observed three bags/purses on shelves accessible to children and adult scissors stored with the children's supplies. This is a potential hazard to children in care. Staff removed items and placed them in a cabinet inaccessible to children. Children do not nap at facility. Per FR there are currently no children with medication. Carbon monoxide detector is wired with facility fire alarm system.

LPA toured the children’s restrooms. Restroom are located outside the classroom. Preschool does not share restroom with other programs. Restrooms were observed to be locked. Per FR, the teacher has the key to let children in as needed. Waiver referenced on license. LPA did not observe waiver at facility. Restrooms were observed to be safe and sanitary with operable sinks and toilets. LPA observed staff taking children to restroom during inspection. Staff supervised the children at all times.
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9
Document Has Been Signed on 02/07/2023 11:03 AM - It Cannot Be Edited


Created By: Denise Gibbs On 02/07/2023 at 10:21 AM
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: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

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 1 out of 4 staff files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2023
Plan of Correction
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2
3
4
Per FR, she will find the missing file and email proof of missing documents by POC date 3/7/23.
Section Cited
Deficient Practice Statement
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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.
SUPERVISOR'S NAME:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063
VISIT DATE: 02/07/2023
NARRATIVE
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LPA provided facility with Lead flyer.

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 Tamara Honegan.


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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 02/07/2023 11:03 AM - It Cannot Be Edited


Created By: Denise Gibbs On 02/07/2023 at 10:21 AM
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: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.3(b)
Indoor Activity Space
(b) The floors of all rooms shall have a surface that is safe and clean.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Carpet in the classroom has dark spots throughout, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
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Per FR, carpet in the classroom will be cleaned within the month, picture will be email to LPA by POC date 3/7/23.
Type B
Section Cited
CCR
101239.2(a)
Drinking Water
(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation, the licensee did not comply with the section cited above. Water was not observed to be available for children outdoors, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
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Per FR, water will be stored in outdoor storage closet and brought out when children are playing outside. FR will send picture to LPA by POC date 3/7/23.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


LIC809 (FAS) - (06/04)
Page: 4 of 9
Document Has Been Signed on 02/07/2023 11:03 AM - It Cannot Be Edited


Created By: Denise Gibbs On 02/07/2023 at 10:21 AM
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: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2023

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
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3
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Based on record review, the licensee did not comply with the section cited above in 3 out of 4 staff files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
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Per FR, she will go the doctor and get proof of immunization. She will have staff bring in immunization's and email proof to LPA by 3/7/23.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 4 staff files. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/07/2023
Plan of Correction
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Per FR, She will find missing file and send proof of Training to LPA by 3/7/23.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023


LIC809 (FAS) - (06/04)
Page: 5 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WEIGAND ELEMENTARY SCHOOL ROOM 6
FACILITY NUMBER: 197402063
VISIT DATE: 02/07/2023
NARRATIVE
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LPA toured the outdoor play area. Children were playing outside during inspection. Outdoor area was observed to have age appropriate toys and material, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing structure to absorb fall. Shade was observed in the outdoors area via a large tree. The drinking faucet in the outdoor area has been removed due to a lead exceedance correction. LPA observed that children did not have water outdoors while they were playing. LPA reminded the Staff One(1), since they removed the faucet, water bottles from indoors must travel outdoors so children can drink freely. Outdoor area is also used by the special education program on campus. Per FR, children are not out at the same time. Waiver referenced on license. LPA did not observe waiver at facility. LPA reminded FR that trash cans with solid waste need tight fitting lids.

LPA reviewed Sign In/Out sheets. All children present were signed in with date, time and full signature of person guardian.

LPA reviewed required posted documentation which includes, 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 in the preschool classroom. Facility records were reviewed for 9148- Earthquake Preparedness form, Daily Schedule and Disaster drill log, last drill conducted 1/30/23. LPA did not observe Menu or Personal Rights posting. LPA provided FR with Personal Rights form to post.

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

Staff records were reviewed at 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. LPA did not observe immunization records for 3 out 4 staff and file for Staff Three(S3) was misplaced and not available for review.

LPA observed the kitchen located on the elementary campus. Facility provides AM snack, PM snack. Food is not cooked at the facility. Prepackaged food is delivered daily. Extra food is discarded. Kitchen was observed to be clean, free of litter, insects and rodents. Cleaning supplies are stored separate from the food. ----------------------PAGE 2
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023
LIC809 (FAS) - (06/04)
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