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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415232
Report Date: 05/16/2024
Date Signed: 05/16/2024 02:28:10 PM

Document Has Been Signed on 05/16/2024 02:28 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:THERESA HUGHES ELEMENTARY SCHOOLFACILITY NUMBER:
197415232
ADMINISTRATOR/
DIRECTOR:		ADRIANA CORTEZFACILITY TYPE:
850
ADDRESS:4242 CLARA STREET, K-4TELEPHONE:
(323) 560-4422
CITY:CUDAHYSTATE: CAZIP CODE:
90201
CAPACITY: 24TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Facility RepresentativesTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 05/16/2024 at 12:45 PM an unannounced Annual/Random Inspection was conducted by Licensing Program Analyst (LPA) Katrina Chicote for the above facility. LPA announced purpose of visit and initially met with Facility Representative (FR), Adriana Cortez, Principal. Facility is currently licensed for a capacity of 24 and currently have 14 enrolled per FR. Principal provided instruction on how to get to classroom, which is located in Room K4 on Theresa Hughes Elementary School campus. Upon arrival to classroom, LPA met with Facility Representatives S1 and S2, classroom teachers. The program currently operates from 7:52 AM to 2:15 PM with the exception of Tuesday where they operate from 7:52 AM to 1:15 PM. Per FR, they follow elementary school campus schedule. LPA provided LIC 125 to FRs. LPA was taken on a guided tour of the facility of both indoors and outdoors. LPA observed required postings in classroom.

At the initial start of the site visit, LPA observed 12 preschoolers napping on mats with sheets and blankets. Mats were inspected. LPA observed children laid out that does not hinder walkways and exits/entrances at time of inspection. Full supervision was observed during nap time. Per FR, linens are provided to the families by the facility and washed weekly by a laundry service.

Beginning at 12:55 PM, furniture and equipment were inspected for age appropriateness and good repair. LPA observed surface of classrooms to be safe and clean, and child size tables and chairs available for children well maintained. LPA observed learning stations for dramatic play, math, and science with toys well maintained free of loose and sharp parts and a library area available for quiet play. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. Availability of drinking water was reviewed. LPA observed children's personal water bottles on cart and per FR, children can also use drinking fountains in classroom to drink from and/or refill their water bottles. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. LPA observed bathroom available in classroom that had two toilets and one sink, additional sink observed in classroom.
Report Continues - Page 1 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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 6
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: THERESA HUGHES ELEMENTARY SCHOOL
FACILITY NUMBER: 197415232
VISIT DATE: 05/16/2024
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A first aid kit is kept in cabinet in classroom, which LPA inventoried for supplies. Per S1, carbon monoxide detectors and smoke detectors are present in the facility and pointed to device on ceiling which LPA observed to have red light indicating it is operable. Disaster drill log was available and last drill conducted on 04/2024. Sick/isolation area will be in school's Nurse's Office. Per S1, hazardous items including poisonous cleaning compounds are not stored in the classroom and they only use Clorox wipes to wipe tables which LPA observed stored in high shelf in classroom. LAUSD janitorial service cleans classroom daily.

Snack/lunch menus were reviewed and observed posted, per menu facility provides Breakfast and Lunch which is provided by school cafeteria.

At 1:02 PM, outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. LPA observed age appropriate play structure with cushioning material below to absorb fall that were all well maintained at time of inspection. LPA observed concrete path through out play area. Per FR, outdoor play area is shared with elementary school and they use staggered play times to ensure no co-mingling. Required shade and fencing were inspected. LPA advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to their water bottles during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

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

All staff and employees have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District (LAUSD).

Beginning at 1:30 PM, children and staff records were reviewed. Children’s records were reviewed for completeness and documented on the LIC 857. Staff records were documented on the LIC 857. Proof of completion for AB1207 Mandated Reporter Training certificate was discussed for S2. CPR card expires on 10/31/2024 for S1. LPA did not review confidential forms due to the files being stored at the administrative office. Report Continues - Page 2 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: THERESA HUGHES ELEMENTARY SCHOOL
FACILITY NUMBER: 197415232
VISIT DATE: 05/16/2024
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The following were discussed:
LPA 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, this includes any changes as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

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

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.

Facility Representative was reminded that all adults 18 and over in the facility, 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 licensed facility. 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.

CCC COMPLETED TESTING AND HAS REMEDIATED LEAD EXCEEDANCES:
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.

LPA referred Facility Representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] 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.
Report Continues - Page 3 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: THERESA HUGHES ELEMENTARY SCHOOL
FACILITY NUMBER: 197415232
VISIT DATE: 05/16/2024
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Incidental Medical Services (IMS) - Child Care Centers
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 facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today, 05/16/2024.

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



Exit interview was conducted and report was reviewed with the Facility Representative, Adriana Cortez.


Report Ends - Page 4 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6