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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495310
Report Date: 09/21/2023
Date Signed: 09/21/2023 03:27:21 PM

Document Has Been Signed on 09/21/2023 03:27 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MICHELLE'S BACKYARD HAWTHORNEFACILITY NUMBER:
197495310
ADMINISTRATOR:MICHELLE DICKINSONFACILITY TYPE:
850
ADDRESS:13560 HAWTHORNE BLVDTELEPHONE:
(310) 386-2373
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
09/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Michelle Dickinson-ApplicantTIME COMPLETED:
03:54 PM
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On 09/21/2023 Licensing Program Analyst (LPA) Jillinda Chandler made an announced visit to Michelle's Backyard Hawthorne preschool for the purpose of conducting a pre-licensing inspection. The applicant also has a pending infant license #197495309. The applicant is requesting a preschool program with a capacity of 24 children, ages 2 - entry into first grade. LPA met with applicant Michelle Dickinson who provided a tour of the facility. The center is located on the campus of Calvary Presbyterian Church, there are 3 classrooms on the campus. The preschool operations will take place in room 3. Days and Hours of operation are: Monday - Friday /7:30 A.M - 6:00 P.M. The directors office is located on the second level of the building, there shall be no day care activities on the second level. An approved fire clearance is on file conducted by inspector Michael Judkins of the Los Angeles County Fire Department Prevention Bureau.

The following was observed of the:

INDOOR ACTIVITY SPACE

Fire extinguishers were 2AB10C or larger was observed, last inspected 2/13/2023

Carbon and smoke detectors were observed, in operable condition.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MICHELLE'S BACKYARD HAWTHORNE
FACILITY NUMBER: 197495310
VISIT DATE: 09/21/2023
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First aid kits were observed with the required essentials: scissors, bandages, tweezers, and thermometer

Age appropriate toys and equipment were observed in good repair.

Air conditioning units and wall heaters were observed in operable condition. Wall heaters were made inaccessible to children in care.



Adequate lighting was observed, windows were free of chipping and debris.

The classrooms were clean, rugs were in good condition

Storage bins for children’s belongings were observed

Trash cans used for solid waste were observed with tight fitting lids

Disinfectants and cleaning solution and other toxins or poisons were made inaccessible to children.

The directors office (upstairs) will be used for isolation of ill children, LPA explained that a restroom should be in close proximity for ill children, per the applicant the closes restroom is located on the lower level. The applicant was informed that there needs to be a crib or pack and play for infants that are required to sleep in a crib.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MICHELLE'S BACKYARD HAWTHORNE
FACILITY NUMBER: 197495310
VISIT DATE: 09/21/2023
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The classrooms were equipped with working telephones.

Persons signing children in and out will sign using the electronic devise "Playground" The sign-in and sign-out sheets with the signatures required by this section and by Section 101226.1 shall be kept for one month and shall be available at the center for review by the Department.

The required postings were also posted in a prominent area for parents and visitor's viewing

The facility did not have cameras in the classrooms or outdoor activity areas, during todays inspection.


The measurements for the indoor activity space was 569.91 for a total of 16 preschool children

FOOD SERVICE:

The center will provide snacks and lunches will be provided by the parents.


Weekly menus shall be posted in a prominent area for review.

RESTROOMS:

LPA observed 3 standard size toilets and 2 sinks with broad based stools to assist children when using these fixtures.

Restrooms were clean and equipped with the necessary toileting essentials.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MICHELLE'S BACKYARD HAWTHORNE
FACILITY NUMBER: 197495310
VISIT DATE: 09/21/2023
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OUTDOOR ACTIVITY SPACE

The play yard was fully gated with a gate approximately 4 feet or higher.

Resilient cushioning was observed, in good repair under all climbing toys.



Measurements for the outdoor activity space were 1833.24 for a total of 24 children. The applicant is requesting a waiver of Title 22, section 101438.2(a). for shared outdoor space

Based on measurements and observations the center shall be recommended for licensure for a capacity of 16 children, pending the following recommendations and waiver approval:

For a license issued on or after July 1, 2022, initial lead testing results shall be received and posted within 180 days of licensure.



Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MICHELLE'S BACKYARD HAWTHORNE
FACILITY NUMBER: 197495310
VISIT DATE: 09/21/2023
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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, available at: http://www.ada.gov/childqanda.htm

Applicant was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the applicant, Michelle Dickinson.

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.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
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