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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416686
Report Date: 04/12/2023
Date Signed: 04/12/2023 04:07:47 PM

Document Has Been Signed on 04/12/2023 04:07 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:WEST ATHENS ELEMENTARY SCHOOL CSPPFACILITY NUMBER:
197416686
ADMINISTRATOR:HAWK, MAXINEFACILITY TYPE:
850
ADDRESS:1110 W.119TH STREET,RM 22 & 23TELEPHONE:
(323) 756-9114
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 24DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Jessica Tomas and NeCole HaywoodTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Manager (LPM) Rita Ramos and Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual inspection to the above facility on 04/12/2023. LPM and LPA arrived at the facility at 08:37AM. LPM and LPA initially met with Staff #1 who guided LPM and LPA on a tour of Room 22 and Staff #3 guided LPM and LPA on a tour of Room 23. LPM and LPA were later met by NeCole Haywood, Assistant Principal, who guided LPM and LPA on a tour of the remainder of the facility. LPA provided a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is a preschool program which consists of 2 classrooms: RM 22 and RM 23. Facility operation hours are Monday to Friday from 8:00 AM to 2:30 PM.

All areas identified on this report were inspected. Upon arrival, the following staff were present during this inspection: Room 22: Staff #1, and #2 with 10 preschoolers; Room 23: Staff #3, #4 and #5 with 14 preschoolers. The facility was observed to be within the license capacity and limitations. The following was observed during the tour of the facility:

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. No Napping equipment (mats/cots) were observed. Age-appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. -----PAGE 1
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: WEST ATHENS ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416686
VISIT DATE: 04/12/2023
NARRATIVE
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Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Disaster drill log was available, last drill was conducted on 2/15/2023. LPM and LPA observed fire extinguishers in each classroom that were serviced on 01/06/2023. Carbon monoxide detectors were not observed.
Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. The facility provides AM and PM snack.
All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste were in good repair. However, bins did not have tight-fitting covers that are kept on. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.
Outdoor playground equipment is in a 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, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. During the inspection, LPM and LPA were made aware that the play yard is currently being shared on a staggered play schedule with 6 other classrooms, grades Kindergarten, Transitional Kindergarten (TK) and Early TK. LPM and LPA advised that an updated outdoor schedule be submitted and that the current waiver in place may need to be updated. LPA advised that no children shall be left without the supervision of a teacher at any time.
All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. There are no firearms stored on the premises. There are no pools or bodies of water at the facility.
Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in.
Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857. ----PAGE 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WEST ATHENS ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416686
VISIT DATE: 04/12/2023
NARRATIVE
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LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Not all staff present have proof of current AB 1207 Mandated Reporter Training certificate on file. Not all staff present have proof against measles, pertussis, and influenza. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.
First Aid supplies were observed in Room 22 in a cabinet. However, the first aid kit in Room 23 did not have all the required items. According to Staff #1 and Staff #3, no medication is administered at this time. The facility was observed to be equipped with an isolation area for any child who becomes ill, and it is located in the nurse’s office.
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
LPA advised the administrator 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 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/inspection-process.
The following deficiencies 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.

Exit interview conducted and report was reviewed with Jessica Thomas, Principal and NeCole Haywood, Assistant Principal. -----PAGE 3
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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Document Has Been Signed on 04/12/2023 04:07 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/12/2023 at 03:31 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: WEST ATHENS ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101230(b)(1)
101230 (b) All children shall be given an opportunity to nap or rest without distraction or disturbance from other activities at the center.(1) A napping space and a cot or mat shall be available for each child under the age of five.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation the licensee did not comply with the section cited above in no cots or mats were observed in the classrooms for children to rest or nap which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
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Principal has contacted district administrator regarding the purchase of cots or mats. Purchase approval pending.
Type B
Section Cited
CCR
101217
101217 Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:(1) Employee's full name.(2) Driver's license number if the employee is to transport children.(3) Date of employment.(4) A statement signed by the employee that he/she is at least 18 years of age.(5) Current home address and phone number.(6) Documentation of the educational background, training and/or experience specified in this chapter.(7) Past experience, including types of employment and former employers.(8) Duties of the employee.(9) Termination date if no longer employed by the child care center.
(10) A signed and dated copy of a Notice - Employee Rights (LIC 9052 [3/03]).(11) A health screening as specified in Section 101216(g).(12) Tuberculosis test documents as specified in Section 101216(g).(13) A signed statement regarding their criminal record history as required by Section 101170(d).(14) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 101170(e).


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onobservaton and record review, the licensee did not comply with the section cited above in only staff #1 had a complete file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
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Principal will have staff complete and submit all missing documents for personnel file.
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:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


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Document Has Been Signed on 04/12/2023 04:07 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 04/12/2023 at 03:43 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: WEST ATHENS ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(a)
101221 Child's Records
(a) A separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onobservation and record review, the licensee did not comply with the section cited above in children did not have complete records on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
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Principal will submit copies of documents missing by POC due date.
Type B
Section Cited
HSC
1596.954
Carbon monoxide detectors required; inspection

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observaton, the licensee did not comply with the section cited above due to LPM and LPA not observing a carbon monoxide detector which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2023
Plan of Correction
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Per Principal, a detector will be purchased by POC due date.
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:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023


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