197416086-3-9-2023-54-CC-DGIS-CPRV8A-20230309151224

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416086
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:12:37 PM

Document Has Been Signed on 03/09/2023 03:12 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	WASHINGTON STATE PRESCHOOL		FACILITY NUMBER:	197416086
ADMINISTRATOR:	LEE, OMAIRA		FACILITY TYPE:	850
ADDRESS:	1421 N. WILMINGTON AVENUE		TELEPHONE:	(310) 898-6008
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 9	DATE:	03/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Alicia Weyeneth, Facility Representative		TIME COMPLETED:	03:30 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 Analysts (LPAs) Denise Gibbs and Rosaura Valenzuela conducted an unannounced annual required inspection at the above facility on 3/9/23 at 1:00PM. LPA met with Alicia Weyeneth, Facility Representative (FR) who guided analysts on a tour of the facility. There were nine children and two staff present when LPAs arrived. This facility operates an AM program, 8AM-11:30AM and a PM Program from, 12PM-2:45PM. Facility is on the campus of Washington Elementary in room B101. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Compton Unified School District. LPAs toured Room B101. Classroom furniture was in good condition, free of loose, sharp and/or pointed parts. Rugs were observed to be flat on the ground to avoid tripping hazards. Floors and surfaces of the classroom were clean and safe. Water is made readily available by via a filtered water station in the classroom and cups. Classroom also has an operable water fountain. LPAs also observed a pitcher of water that can be taken outside so children can have access to water. Children have cubbies to store personal belongings. Children do not nap at the facility due to having part time programs. Per staff there are currently no children with medication. Per, Early Childhood Director, required water lead testing has been completed. All documentation is kept a the district office. LPA did not observe posted water lead testing results. LPAs toured the children restroom. Restroom is located inside preschool classroom and is used only by preschool children. Restroom was observed to be safe and sanitary with operable sinks and toilets. LPAs reviewed Sign In/Out sheets located in the classroom. All children present were signed in with the date, time and full signature of guardian. ---------------------PAGE 1

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WASHINGTON STATE PRESCHOOL	FACILITY NUMBER: 197416086
	VISIT DATE: 03/09/2023

NARRATIVE

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Outdoor space has age appropriate toys and material. Presschool yard is used only by preschool children. LPAs observed required cushioning under climbing structure to absorb fall. Cushioning was discussed with FR. Shade was observed in the outdoor area. Water was observed to be available for children via a pitcher and cups that is brought out from the classroom.

LPA observed required posted documentation in the classroom which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, PUB 269- Child Passenger Restraint System, Licensing Form LIC 613A- Notification of Personal Rights, Daily Schedule and Lunch/Snack Menu.

Facility records were reviewed for LIC 9148- Earthquake Preparedness form, LIC 9040- Children's Roster and LIC 610- Facility Disaster Plan. Disaster drill was last drill conducted 1/18/23. All documents observed.

Children’s records were reviewed for LIC 700- Identification and emergency information, LIC 627- Consent for Medical, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. 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, Teacher's Permit and current Mandated Reporter Training Certificate. Files were discussed.

LPAs observed the kitchen located on the elementary campus. Facility provides Breakfast and Lunch. Food is not cooked at the facility. Prepackaged food is delivered daily and warmed at the facility. Extra food is stored is discarded daily. Kitchen was observed to be clean, free of litter, insects and rodents. All trash cans have tight fitting lids for solid waste. Cleaning supplies are stored separate from the food. Carbon Monoxide detector is wired with smoke and fire alarm.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WASHINGTON STATE PRESCHOOL	FACILITY NUMBER: 197416086
	VISIT DATE: 03/09/2023

NARRATIVE

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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 Representatives, Alicia Weyneth.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/09/2023 03:12 PM - It Cannot Be Edited

Created By: Denise Gibbs On 03/09/2023 at 02:19 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: WASHINGTON STATE PRESCHOOL	FACILITY NUMBER: 197416086
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

100700(c)(1)

Written Directives for Lead Testing

(1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. 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, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/31/2023
	Plan of Correction
1 2 3 4	Per FR, she will scan the report to the ECE directors and ask for a copy of the lead results. Once results are sent she will post results, take a picture and email picture to LPA by POC date 3/31/23.

Section Cited


	Deficient Practice Statement
1 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:

Karen Chambers

LICENSING EVALUATOR NAME:

Denise Gibbs

LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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