197416698-6-6-2023-58-CC-LHEZ-CSJTTS-20230606150114

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416698
Report Date: 06/06/2023
Date Signed: 06/06/2023 03:01:31 PM

Document Has Been Signed on 06/06/2023 03:01 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:	186TH STREET ELEMENTARY SCHOOL CSPP		FACILITY NUMBER:	197416698
ADMINISTRATOR:	REED, MARCIA S.		FACILITY TYPE:	850
ADDRESS:	1581 WEST 186TH STREET ROOM 9		TELEPHONE:	(310) 324-1153
CITY:	GARDENA	STATE: CA	ZIP CODE:	90248
CAPACITY:	23	CENSUS: 12	DATE:	06/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Antonio Aguilar, Principal		TIME COMPLETED:	03:15 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) Lilia Hernandez conducted an unannounced annual inspection to the above facility on 06/06/2023. LPA arrived at the facility at 8:45AM, identified self and met with Antonio Aguilar, Principal, who guided analyst on a tour of the facility. LPA provided Licensee/facility representative with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is a state preschool program. Hours of operation are Monday – Friday, AM Session 8:00AM – 11:00AM and PM Session 12:00PM – 3:00PM. There were 12 children and 4 staff present when LPA arrived and in compliance with Title Five ratios. All individual’s present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. At 9:04AM LPA observed the facility providing care and supervision in Room 36. Per principal, on 08/06/2022 an email was submitted requesting a change in classroom location. Principal requested to move the state preschool program from Room 9 to Room 36. Although an application was submitted, change in classroom was made before and a fire clearance approval and a capacity determination could be made, therefore a Type B citation was issued today. LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Parent’s Rights and Breakfast/Lunch Menu for the last 30 days.

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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 11

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: 186TH STREET ELEMENTARY SCHOOL CSPP	FACILITY NUMBER: 197416698
	VISIT DATE: 06/06/2023

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

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. 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.
Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Carbon monoxide detectors were observed and are operable.
Per principal, the isolation area is in the nurse’s office. Per principal and school nurse, there are not children with medication on file.

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.

LPA reviewed Sign In/Out sheets located near the classroom entrance. 9 of the 12 children present were signed in. However, no drop off time was documented on the sign in/out sheet. children present were signed in with date, time and full signature of person guardian.

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. Per principal, solid waste bags are discarded at 9:00AM after each meal.

At 9:11AM LPA observed the trash can to be full and did not have a tight fitted lid. (photo taken)

At 9:20AM LPA toured the children’s bathroom. Children’s bathroom is located outside of Room 36 next to Room 30. These bathrooms are shared with other age groups. Per principal these restroom are used by preschool children, transitional kindergarten children and first grade children. ---PAGE 2 of 4

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

Page: 9 of 11

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: 186TH STREET ELEMENTARY SCHOOL CSPP	FACILITY NUMBER: 197416698
	VISIT DATE: 06/06/2023

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

LPA advised principal that a waiver will need to be requested for the shared used of the bathrooms. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed.

LPA toured the outdoor play area and was observed to have playground equipment in safe conditions, 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. Availability of outdoor drinking water not observed. Per teacher and principal, children bring drinking water in personal water bottles and a supply of bottled water is available should children need water refills. LPA advised that no children shall be left without the supervision of a teacher at any time.
There are no pools or bodies of water at the facility.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present did/did not have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present did/did not have proof against TB, measles, pertussis, and influenza. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

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 -------PAGE 3 of 4

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

Page: 8 of 11

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: 186TH STREET ELEMENTARY SCHOOL CSPP	FACILITY NUMBER: 197416698
	VISIT DATE: 06/06/2023

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

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: LPA provided the Licensee/Director/Principal with a copy of the Effects of Lead Exposure form during the inspection and discussed the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

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.

Appeal rights, copy of report, and a notice of site visit was given that must remain posted for 30 days.

Exit interview conducted and report reviewed with Antonio Aguilar, Principal.

PAGE 4 of 4

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

Page: 10 of 11

Document Has Been Signed on 06/06/2023 03:01 PM - It Cannot Be Edited

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: 186TH STREET ELEMENTARY SCHOOL CSPP	FACILITY NUMBER: 197416698
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101179(b)

101179 Capacity Determination (b) The number of children for which the child care center is licensed to provide care and supervision shall be determined on the basis of the Department's application review, which shall take into consideration the following...child care center. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in change in classroom was made before and a fire clearance approval and a capacity determination could be made, which posed a potential health, safety or personal rights risk to children in care.
	POC Due Date: 06/09/2023
	Plan of Correction
1 2 3 4	Principal will resubmitted LIC200A application requesting classroom change along with facilty sketch and statement with details regarding change of classroom.

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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

Page: 11 of 11