197416071-6-28-2022-30-CC-KSCT-CFTVXU-20220628165007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416071
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:53:11 PM

Document Has Been Signed on 06/28/2022 04:53 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	ANTOINE'S LITTLE ANGELS		FACILITY NUMBER:	197416071
ADMINISTRATOR:	ANTOINE, DOMINIQUE		FACILITY TYPE:	850
ADDRESS:	11111 S. WESTERN AVENUE		TELEPHONE:	(323) 757-3980
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 3	DATE:	06/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:26 PM
MET WITH:	Janice Antoine- Licensee, Dominique Antoine- Director		TIME COMPLETED:	05:00 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 Analyst (LPA), Keyona Scott, conducted an unannounced annual required inspection on 06/28/2022. LPA met with Licensee Janice Antoine and Director Dominique Antoine at 10:28 AM and was guided on tour inside and outside of the facility. This is a preschool program that consists of one open space room that is divided into sections. Facility operation hours are Monday through Friday from 7:30 AM to 5:45 PM based on parents needs. There is also an infant program with facility number 197416072 on the premises. Children's sign in/out sheets were reviewed. All areas identified on the Facility Sketch were inspected. Census was taken and LPA observed three (3) children in care with the proper teacher to child ratio.

PHYSICAL PLANT

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Per Director, poisons are located in the kitchen under the sink. LPA observed safety latch on cabinet under kitchen sink. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing facilities are safe, sanitary and are operating properly. All floors are clean and safe.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors. The facility was observed to be free of flies, other insects and rodents.

Outdoor playground equipment is in 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. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard Page 1.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ANTOINE'S LITTLE ANGELS	FACILITY NUMBER: 197416071
	VISIT DATE: 06/28/2022

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
26
27
28
29
30
31
32

FACILITY RECORDS

All individuals present have obtained a criminal record clearance. There is at least one person trained in CPR and Pediatric First Aid. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed.

In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

Disaster drill is posted and available for review. Disaster drills are conducted at least once a month.

Parent(s)/authorized representative(s) provide food for child(ren). As an alternative, food is available on the premises if needed. Menus are posted and available to review in a visible location for child's parent/authorized representative.

The following was thoroughly discussed:
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Director 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.

Page 2

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ANTOINE'S LITTLE ANGELS	FACILITY NUMBER: 197416071
	VISIT DATE: 06/28/2022

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
26
27
28
29
30
31
32

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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.

The facility was operating in substantial compliance during today’s inspection on 06/28/2022. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

Notice of Site Visit

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

Exit Interview

Exit interview conducted and report was reviewed with Licensee, Janice Antoine.

Page 3

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5