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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416071
Report Date: 06/22/2023
Date Signed: 06/28/2023 03:04:19 PM

Document Has Been Signed on 06/28/2023 03:04 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 ANGELSFACILITY NUMBER:
197416071
ADMINISTRATOR:ANTOINE, DOMINIQUEFACILITY TYPE:
850
ADDRESS:11111 S. WESTERN AVENUETELEPHONE:
(323) 757-3980
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 23TOTAL ENROLLED CHILDREN: 5CENSUS: 5DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:12 AM
MET WITH:Janice AntoineTIME COMPLETED:
01:13 PM
NARRATIVE
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On 6/22/2023 Licensing Program Analyst (LPA) Jillinda Chandler made an unannounced visit to Antoine's Little Angels preschool for the purpose of conducting a Required 1 Year Annual inspection. Upon arrival there were 5 children being supervised by licensee- Janice Antoine and 1 assistant Dominique Antoine, also present was the licensee's spouse- Cutie Antoine. All adults present received a criminal back ground clearance. LPA inspected the facility for Health and Safety compliance per Title 22.
The centers days and hours are from 6:00 a.m. - 6:00 p.m. or as parents needs require.

THE FOLLOWING WAS OBSERVED:
The floors in the classroom was observed to be in good condition.
Age appropriate toys, furniture and equipment were observed to be in fair condition, free of sharp, loose, or pointed parts.
Disinfectants, cleaning solutions, medication and other items that are dangerous to children were inaccessible to children in care.
Trash cans in the classroom had tight fitting lids.
Drinking water is readily available.
Children have individual cubbies to store their personal belongings
LPA observed a refrigerator in the kitchen for storage of medication in need of refrigeration. LPA advised licensee to remove foods that have expired and label foods that were opened with the date they were opened and children's names.
The rooms temperature was set at a comfortable temperature, facility uses a fans and a heating unit, for heating and cooling.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ANTOINE'S LITTLE ANGELS
FACILITY NUMBER: 197416071
VISIT DATE: 06/22/2023
NARRATIVE
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Required posting were observed in a prominent area for review, postings were inside the center.
Meals are provided by parents.
LPA observed a first aide kit with the required essentials: scissors, tweezers, ointments, bandages and a thermometer.
The isolation area is located in the directors office and a designated restroom will be used by ill children
Sinks and toilets were inspected and observed in operable condition
The facility has indoor and outdoor cameras
Cots were observed for napping, cots were found to be in good condition.
LPA observed a changing table within arms reach of a sink, licensee was advised, per Title 22, section 101239(h)(3) changing tables shall have raised sides at least three inches high.
Carbon Monoxide detectors were present, Fire extinguishers were last inspected on 10/7/2022
OUTDOORS ACTIVITY AREA
Outdoor playground surface was safe. LPA observed a brick wall in need of repair, LPA advised the Licensee to devise a plan to ensure the sharp edges are not a safety hazard. Licensee was advised to replace damaged shading, make water hose inaccessible to children in care. Per Licensee the yard that was used for the infant will be re-cushioned. Wood chips were observed for cushioning under the climbing apparatus.
FACILITY RECORDS
Staff files were reviewed and found to be current
All individuals present had not obtained a criminal record clearance or criminal record exemption.
Licensee and assistant's Pediatric CPR and First Aid expires 6/23/2025
Licensee and assistants Mandated Reporter Certification expires 7/5/2024
A review of children’s files, found the records to be complete and up-to-date.
Licensee shall post and provide parents with an updated LIC 995 - Parents Rights, to reflect the current address and telephone number for the Department.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ANTOINE'S LITTLE ANGELS
FACILITY NUMBER: 197416071
VISIT DATE: 06/22/2023
NARRATIVE
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LPA also informed licensee 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.
Licensee 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.
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). CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE,
LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 06/28/2023 03:04 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 06/22/2023 at 12:14 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: ANTOINE'S LITTLE ANGELS
FACILITY NUMBER: 197416071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)


This requirement is not met as evidenced by: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
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above, Licensee did not provide Lead Testing certification which poses potential health, risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Licensee shall provide proof of testting or obtain a appointment with a Certified External Water Sampler, no later than June 30, 2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ANTOINE'S LITTLE ANGELS
FACILITY NUMBER: 197416071
VISIT DATE: 06/22/2023
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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/. PIN 22-05-CCP Page Five

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

Exit interview conducted and report was reviewed with the licensee Janice Antoine.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee has agreed to be referred to the departments Technical Support Program (TSP)
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/28/2023 03:04 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 06/22/2023 at 02:55 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: ANTOINE'S LITTLE ANGELS
FACILITY NUMBER: 197416071

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

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, Licensing Program Analyst (LPA) obseverd a broken brick wall with jagged edges which posed a potential safety risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Licensee shall immediately devise a plan to make the wall inaccessible to children in care. During todays visit licensee had a repair person to come repair the wall. LPA will make a return visit to inspect the repair. No later than 6/30/23
Type B
Section Cited
CCR
101227(a)(18)
Food Service
(18) All kitchen, food-preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin.

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,Licensing Program Analyst (LPA) observed, un labeled foods, uncleaned dishes in the sink and the refrigerator was in need of cleaning which poses a potential health risk to persons in care.
POC Due Date: 06/30/2023
Plan of Correction
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Licensee shall Immediately label foods, and clean used kitchen utensils and equipment. Licensing Program Analyst shall make a return visit no later than 6/30/2023 to observe corrections.
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023


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