197495206-8-29-2023-30-CC-LCLN-CV6SPE-20230829140257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495206
Report Date: 08/29/2023
Date Signed: 08/29/2023 02:04:33 PM

Document Has Been Signed on 08/29/2023 02:04 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	VILLAGE TREE INFANT CENTER		FACILITY NUMBER:	197495206
ADMINISTRATOR:	KIMBERLY KERN		FACILITY TYPE:	830
ADDRESS:	3608 CLARINGTON AVENUE		TELEPHONE:	(310) 876-0116
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY: 18	TOTAL ENROLLED CHILDREN: 18	CENSUS: 12	DATE:	08/29/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	KIMBERLY KERN, DIRECTOR		TIME COMPLETED:	02:45 PM

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On 08/29/2023, Licensing Program Analyst (LPA) Lisa Clayton conducted an unannounced Annual Required Inspection for the Child Care Center. LPA Clayton met with Director Kimberly Kern, and Lead Teacher Hazel Gopilan. LPA Clayton toured the facility indoors and outdoors. LPA Clayton observed 10 infants in care, being supervised and cared for by 6 staff members. Facility hours of operation are 8:00am – 5:30pm (August – June) and 8:30am – 3:30pm (mid June – mid August). CCC provides snack only.

Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities.

All children are under supervision, including visual supervision, of a teacher at all times.

There are no swimming pools, ponds, or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked cabinet area. No poisons or other hazardous materials were observed during the inspection.

The CCC has 2 fully charged 2A:10BC Fire Extinguishers, a working carbon monoxide detector, and a working Pull Fire Alarm system that meet statutory requirements.

Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Playground equipment is in 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. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe.

There is a ratio of one teacher supervising no more than three infants in care. The name of the childcare center director or fully-qualified teacher designated to act in the director’s absence is posted and has been reported to the Department. Parents use a QR code to sign their child in/out of the facility and their full legal signature and record the time of day appears on record.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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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Document Has Been Signed on 08/29/2023 02:04 PM - It Cannot Be Edited

Created By: Lisa Clayton On 08/29/2023 at 12:34 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: VILLAGE TREE INFANT CENTER	FACILITY NUMBER: 197495206
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and Director statement, the staff are not documenting the 15 minute checks (sleep log) on sleeping infants in care, which poses a potential Health and Safety risk to chidren in care.
	POC Due Date: 08/29/2023
	Plan of Correction
1 2 3 4	Director will ensure that the as directed in the Infant Safe Sleep regulation, staff will check on sleeping infants and document the following: 1. Labored breathing., 2. Signs of distress, which includes but is not limited to flushed skin color, increase in body temperature, and restlessness.

Type B

Section Cited

CCR

101419.2(b)(2)

Infant Needs and Services Plan

(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and Director statement, no LIC 9227 forms have been distrubuted to parents and/or auth representatives of children in care, which poses a potential Health and Safety risk to chidren in care.
	POC Due Date: 08/29/2023
	Plan of Correction
1 2 3 4	Director will provide parents/auth representatives of children in care, the LIC 9227 form no later than the close of business today -8/29/2023, and place the completed and signed forms in the children's files.

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:

Karren Starks

LICENSING EVALUATOR NAME:

Lisa Clayton

LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: VILLAGE TREE INFANT CENTER	FACILITY NUMBER: 197495206
	VISIT DATE: 08/29/2023

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LPA reviewed 5 children’s files and observed files included the Infant Needs and Services Plan, and current contact information for authorized representatives and/or relatives who can assume responsibility for the child, immunization records, and authorization for medical treatment. LPA reviewed a sample of 5 staff files. Staff who are trained in Pediatric First-Aid/CPR have current certifications and all staffs Mandated Reporter training is current.

Director 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.

LPA discussed the safe sleep regulations with Director Kim, and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensinq/public-information-and resources/safe-sleep, as an additional resource. LPA also informed Director 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.

IMS Services are NOT being provided at the time of the inspection. LPA Clayton provided Director with an IMS plan Sample to be used as needed. For IMS information see PIN 22-02-CCP. 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/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: VILLAGE TREE INFANT CENTER	FACILITY NUMBER: 197495206
	VISIT DATE: 08/29/2023

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LPA Clayton reminded Director to access the Community Care Licensing website www.ccld.ca.gov for access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations. 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.

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.

LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information and Director will contact LPA Clayton no later than October 2023 regarding Lead Testing.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited (see LIC809D).

Exit interview conducted, and report was reviewed with Director Kimberly. A notice of site visit and Appeal Rights were provided. Notice of Site visit must remain posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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