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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416694
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:45:42 PM

Document Has Been Signed on 12/12/2023 04:45 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:WASHINGTON PRIMARY CENTERFACILITY NUMBER:
197416694
ADMINISTRATOR:ALLISON SPEIGHTFACILITY TYPE:
850
ADDRESS:860 W. 112TH STREET RM K1 & K2TELEPHONE:
(323) 779-7550
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 8DATE:
12/12/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Mary Seay, Principal TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual inspection to the above facility on 12/12/2023. LPA arrived at the facility at 9:25AM, identified self and met with Mary Seay, Principal, who guided analyst on a tour of the facility. LPA provided Principal with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is a preschool program which consists of 2 classrooms: Room K1 and Room K2. Facility operation hours are Monday to Friday from 7:50 AM to 2:13 PM.

Per Principal, Room K2 is being used as a universal transitional kindergarten classroom. (UTK) Room K1 is the only classroom used for preschool. Principal was advised to submit a written statement to the department regarding changes of capacity and current use of Room K2. LPA also advise that current waivers for bathroom and outdoors activity space will need to be updated to reflect changes to the license.

All areas identified on the Facility Sketch were inspected.

There were 8 children and 2 staff present when LPA arrived. The facility was observed to be within the license capacity and limitations.

Criminal record clearance was not reviewed. However, per condition of employment with the Los Angeles Unified School District, all individual’s present have obtained a criminal record clearance or criminal record exemption.

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. LPA observed children’s personal belongings stored on a shelf with no individual space identified for children. Children’s jackets and beanies were also observed hanging on hooks in the dramatic play area. (photos taken) ---Page 1 of
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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 8
Document Has Been Signed on 12/12/2023 04:45 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 12/12/2023 at 02:53 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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
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 observation, the licensee did not comply with the section cited above in LPA did not observe a carbon monoxide detector in the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per principal, carbon monoxide will be purchased installed and a photo of correction will be submitted via email to LPA by the POC due date.
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in facility was not able to provide documentation for lead testing results which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per Principal, lead testing results will be obtained and copies will be submitted via email to LPA 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: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 12/12/2023 04:45 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 12/12/2023 at 02:53 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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.4(a)
Storage Space
(a) The licensee shall ensure that each child has an individual permanent or portable storage space for his/her clothing, personal belongings and/or bedding.

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 in LPA observed children's personal belongings stored on a shelf with no individual space identified for children. Children's jackets and beanies were also observed hanging on hooks in the dramatic play area. (photos taken) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per principal, proof of purchase will be submitted via email to LPA by POC due date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in facility did not have personnel files for LPA to review. 2 of 2 personnel did not have mandated reporter training completed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per principal, staff will be provided with website to complete training and certificate of completion will be submitted via email to LPA 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: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 12/12/2023 04:45 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 12/12/2023 at 02:53 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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in Facility did not have personnel files for LPA to review. 2 of 2 personnel did not have immunization records on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per principal, immunization's records will be obtained, filed at facility and copies will be submitted via email to LPA by POC due date.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in Facility did not have personnel files for LPA to review. 2 of 2 personnel did not have a current First aid and CPR certificate on file which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/20/2024
Plan of Correction
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Per principal, copies of current First Aid and CPR training certificates will be obtained, filed at facility and copies will be submitted via email to LPA 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: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 12/12/2023 04:45 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 12/12/2023 at 02:53 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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(a)
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:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in Facility did not have 2 of 2 staff personnel files that includes staff qualifications, LIC9108 Statement Acknowledging Requirements to report Child abuse, and LIC9052 Employee Rights for LPA to review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per principal, personnel file to be kept at facility will be created, missing documentation mentioned above will be filed and copies will be submitted via email to LPA by POC due date.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in LPA observed 8 of 8 children present did not have time of day recorded on the sign in/out sheets which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/19/2024
Plan of Correction
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Per principal, sign in/out sheets from 12/13/2023 - 12/15/2023 and 01/8/2024 - 01/19/2024 will be submitted via email to LPA 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: 12/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2023


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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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694
VISIT DATE: 12/12/2023
NARRATIVE
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Mats and linens are provided for each child enrolled. Linens are washed weekly by school district. LPA observed napping equipment (mats) were observed in a separate storage room. Age-appropriate sinks and toilets were inspected for availability and good repair in the restrooms. Each classroom also has an additional sink for handwashing. General sanitation was observed. Availability of indoor drinking water was observed outside the classroom.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Principal states that poisons are locked in the hopper room.

LPA did not observe a carbon monoxide detector in the facility.

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, 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 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. LPA observed a shaded area with benches to sit on. Availability of outdoor drinking water was observed.

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.

Per Principal, there are no firearms stored on the premises. LPA did not observe pools or bodies of water at the facility.

Child care center completed sampling but the test results are not yet available. LPA referred Principal to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. ---Page 2 of
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2023
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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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694
VISIT DATE: 12/12/2023
NARRATIVE
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LPA was not able to verify if there is at least one person trained in CPR and Pediatric First Aid present during this inspection.
Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857.

Facility did not have personnel files for LPA to review. 2 of 2 personnel did not have mandated reporter training completed. 2 of 2 personnel did not have immunization records on file. Facility did not have 2 of 2 staff personnel files that includes staff qualifications, LIC9108 Statement Acknowledging Requirements to report Child abuse, and LIC9052 Employee Rights for LPA to review.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. LPA observed 8 of 8 children present did not have time of day recorded on the sign in/out sheets.

Menus are posted one month in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. The facility provides breakfast, lunch, and snack to children. Food is prepared in the main elementary cafeteria next door to the facility. Meals are brought to the facility daily.

Disaster drill log was available, last drill was conducted on 11/30/2023.

First Aid supplies were observed in the classroom in the emergency backpack. According to Principal, medication is only administered to a child when accompanied with a doctor's note and is stored in the office. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the nurse office.

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/. ---Page 3 of
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2023
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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: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694
VISIT DATE: 12/12/2023
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.

Principal 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.

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 Mary Seay, Principal.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/12/2023
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