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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416054
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:10:49 PM

Document Has Been Signed on 10/16/2024 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KIDS PARK NORTHRIDGE (SA)FACILITY NUMBER:
197416054
ADMINISTRATOR/
DIRECTOR:		ROSS, DAVIDAFACILITY TYPE:
840
ADDRESS:9056 TAMPA AVENUETELEPHONE:
(818) 998-5437
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: DATE:
10/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Tania Reyes, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 10/16/2024 at 12:45 PM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced 3 Year Annual Required Inspection. Facility is located at 9056 Tampa Avenue, Northridge, CA 91324. LPA identified self and met with Tania Reyes, Assistant Director, LPA identified reason for visit and provided Entrance Checklist -Child Care Centers (LIC 125) to help facilitate the inspection.

Facility Representative (FR) Tania Reyes, Assistant Director allowed entry to facility and provided LPA a guided tour of inside of the facility. The facility is currently licensed for a capacity of 25, per FR they currently have 608 enrolled and they are a drop-in care center. The facility hours of operation are currently Monday thru Friday from 08:00 AM to 08:00 PM and Saturdays 10:00 AM to 10:00 PM.

Required postings were observed posted in the lobby area and the facility outdoor play area wavier is pending Department reissuance.

The facility is an open concept large room with divided areas and with a line of sight across the entire room. There are four sections divided by low walls and child gates; Section 1 near the front of facility is for school age children, Section 2 is used for day care activities -play, toys, dolls and building blocks, Section 3 is for dramatic active play – play, running, climbing, there is a climbing structured covered with carpet to absorb falls, Section 4 is for eating, art projects, theater.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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Document Has Been Signed on 10/16/2024 04:10 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 10/16/2024 at 03:35 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KIDS PARK NORTHRIDGE (SA)
FACILITY NUMBER: 197416054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 5 out 5 childrens records did not contain a medical assessment and was not readily available upon request by the department, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/18/2024
Plan of Correction
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Per Assistant Director, the facility will request medical assessment for enrolled children and provide LPA a copy of the form by the plan of correction due date of 11/18/2024.
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 5 out 5 childrens records did not contain a signed consent form for medical treatment and was not readily available upon requst by the department, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/19/2024
Plan of Correction
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Per Assistant Director, the facility will request consent for medical treatment for enrolled children and provide LPA a copy of the form by the plan of correction due date of 11/18/2024.
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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


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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: KIDS PARK NORTHRIDGE (SA)
FACILITY NUMBER: 197416054
VISIT DATE: 10/16/2024
NARRATIVE
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Beginning at 01:00 PM, LPA observed the following in each section. The furniture, toys, and equipment were inspected for age appropriateness and were in good repair. There were cubbies used for each child to store their belongings and lunch. There were standard cots and bed linens provided by the families and taken home for washing or the Center will provide the bed linens. Drinking water was readily available and disposable cups were available for children to use. The restrooms were inspected for safety and sanitation. There were age-appropriate sinks and toilets located in Section 4 at the back of the facility open room, there was available water, water temperature was appropriate, toilet paper was provided. There is telephone service, heating, lighting and ventilation were evaluated for safety and comfort.

LPA observed a first aid kits in located in the Section 4 kitchenette cabinet and the office and inventoried for necessary supplies. LPA observed a device high on the ceiling per FR it is a carbon monoxide detector. LPA observed smoke detector via fire alarm. Disaster drill log was available and the last drill was on 09/23/2024. Per FR, isolation area for sick children is to use an area away from other children near the front office. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. LPA observed cleaning solutions stored in high cabinets and high shelves in the kitchenette and teacher’s restroom.

LPA did observe a kitchenette area, per FR meals and snacks are provided and stored in the kitchenette. Facility prepares meals and snacks for children and meal and snack menus were reviewed and posted in lobby. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.

The facility does not have an outdoor play area. The facility has an outdoor play area wavier. The facility has a large indoor play area that measures 3,783 square feet, using 60 square feet per child, the indoor space would allow a capacity of 55 children. Facility is a combination center with preschool and school age children.


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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIDS PARK NORTHRIDGE (SA)
FACILITY NUMBER: 197416054
VISIT DATE: 10/16/2024
NARRATIVE
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Beginning at approximately 01:30 PM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. Staff records were complete. Children records were incomplete, missing Physicians Report and Health History and Consent for Medical Treatment. Criminal Record Clearances were reviewed for adults. CPR card expires on 04/2025 for Assistant Director.

LPA observed that teacher-child ratios were maintained, and staff names were 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 no children signed in at time of inspection.

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/.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.


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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: KIDS PARK NORTHRIDGE (SA)
FACILITY NUMBER: 197416054
VISIT DATE: 10/16/2024
NARRATIVE
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CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE
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 with the Written Directives outlined in PIN 21-21.1-CCP.

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

There are currently no infants enrolled at the facility. LPA discussed the safe sleep regulations with licensee facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and­resources/safe-sleep as an additional resource.

LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.


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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: KIDS PARK NORTHRIDGE (SA)
FACILITY NUMBER: 197416054
VISIT DATE: 10/16/2024
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.

The following Type B deficiencies for 101221(b)(8) Childs Records -Medical Assessment and 101221(b)(8)(c) Childs Records – Consent for Medical Treatment and listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22,

A Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to comply with posting requirement will result in an immediate civil penalty of $100.00.

Exit interview was conducted with Tania Reyes, Assistant Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.




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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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