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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001351
Report Date: 02/23/2023
Date Signed: 02/23/2023 03:32:17 PM

Document Has Been Signed on 02/23/2023 03:32 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:92ND & MAIE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198001351
ADMINISTRATOR:ALICIA GARCIAFACILITY TYPE:
850
ADDRESS:9200 MAIE AVE.TELEPHONE:
(323) 249-0621
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 27DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Edwina ShriverTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAS) Franchesca White and Denise Gibbs conducted an unannounced annual required inspection at the above facility on 02/23/2023 at 9:45 a.m.. LPAS met with Edwina Shriver, Interim Director.

LPAS began tour of this preschool program with toddler option which consists of 5 classrooms (2 - Preschool / 2 Toddler, and 1 Transitional Classroom used specifically for therapy sessions.). Facility operation hours are Monday-Friday 6:00AM-6:00PM. There were 27 children present when LPAS arrived.

Facility is in compliance with license capacity and Title 22 ratio guidelines. All individuals present have obtained a criminal record clearance.

At 10:14 a.m., LPAS toured all classrooms. Daily Schedules were posted in all classrooms. Classrooms had furniture in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. There are age appropriate toys and material for children to play with. According to Toddler teachers, there are currently 2 children with medication at the facility. Children have cots for napping. Bedding is provided by facility and washed every Thursday. First aid kits were observed in each classroom. Preschool Classrooms share a filtered watering unit with paper cups for each child.

LPAS toured the children’s restrooms. The two preschool classrooms share a bathroom with two toilets and two sinks. LPAS observed a preschool child going to the bathroom from 92m (1A) to 92m (1B) unattended. Restrooms were observed to be safe and sanitary with operable toilets.


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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: 92ND & MAIE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198001351
VISIT DATE: 02/23/2023
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At 10:25 a.m., LPAS toured 2 Toddler Classrooms. Each room had age appropriate toys free of loose, sharp and/or pointed parts. Floors and surfaces in the classrooms were clean and safe. Changing tables were clean and organized with cleaning agents stored in an area inaccessible to children. Toddler classrooms share a filtered watering unit with paper cups for each child. Toddler classrooms (2A/2B) shares a bathroom with two toilets and two sinks in the 92M (2A) room.

At 10:45 a.m., LPAS toured Toddler playground outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. Required shade and fencing were inspected. LPAs observed outside play area to be fully fenced with shade available for children. LPAs observe the preschool playground separated by a gate from the toddler play area. LPAs observed bicycles and other ride along toys available for children outside that are well maintained. LPAs observed barn storage shed with operable lock at time of inspection. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water observed at time of inspection.

Snack/lunch menus were reviewed and observed posted. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. At 10:55 AM, food preparation areas were toured for safety, cleanliness and proper equipment. LPAs observed Kitchen area to be free of clutter and well maintained at time of inspection. Per FR, food is not prepared on site.

LPA observed required posted documentation outside of the classrooms, which included License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, and LIC 613A- Notification of Personal Rights and AM/PM snack and Lunch Menu. All documents were observed.

LPAS observed all children files, signed consent for medication from parents and doctor missing for Child 3 (C3). Upon reviewing the medication for C3, it was found to be expired as of 1/2023.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 2/23. All documents were observed. Carbon monoxide detector was tested and working properly at time of inspection.
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: 92ND & MAIE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198001351
VISIT DATE: 02/23/2023
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Required Water Lead Testing has been completed. Lead results were observed and posted. Other required documents were discussed.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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/process.

Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home.

A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Edwina Shriver.


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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: 92ND & MAIE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198001351
VISIT DATE: 02/23/2023
NARRATIVE
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 A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Edwina Shriver.




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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/23/2023 03:32 PM - It Cannot Be Edited


Created By: Franchesca White On 02/23/2023 at 02:41 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: 92ND & MAIE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198001351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

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 1 out of 2 children's medications. Medication expired 1/2023, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Return the medication to the parent
Training your teachers on medication policies
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

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 1 out of 2 children's medication. Parent and Physician consent was not observed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Ask parent for consent form from doctor
Have parent to sign medication form
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:Valarie Cook
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023


LIC809 (FAS) - (06/04)
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