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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009398
Report Date: 10/22/2024
Date Signed: 10/22/2024 02:36:41 PM

Document Has Been Signed on 10/22/2024 02:36 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. BARNABAS PRESCHOOLFACILITY NUMBER:
198009398
ADMINISTRATOR/
DIRECTOR:		PATRICIA JOHNSONFACILITY TYPE:
850
ADDRESS:1130 MARSHALL PLTELEPHONE:
(562) 988-8481
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 15DATE:
10/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Acting Director- Suzanne WrenTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On October 22, 2024 at 9:15a.m., Licensing Program Analysts (LPAs) Keneisha Dunlap and Dayna Chambers arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Acting Director- Suzanne Wren. The Acting Director guided LPA’s on tour of facility. There were 15 children enrolled, 15 children present, and 2 staff present at the time of inspection. The hours of operation are Monday- Thursday from 7:50a.m-2:50p.m.,Friday from 7:50a.m.-12:50p.m. All adults at the facility were discussed and background and fingerprinted cleared. License, facility sketch, disaster plan, parent rights, and PUB 393 posted. Facility does have a current disaster log drill with date of 9/19/24. Licensee does have current LIC9040 (facility roster). Parents provide lunches for the children therefore a menu was not posted. Daily schedule posted in classroom.

The facility has one classroom that includes cabinet space for material and supplies with a sink. LPA's observed cleaning solution stored inside high top cabinet making it inaccessible for children to reach. The classroom has age appropriate tables, cubbies for personal belongings, dramatic play area, library, and age appropriate toys. All electrical outlets in the classroom were covered. There is a water cooler in the classroom near the exit door that is accessible to children during indoor and outdoor play, and the children also have their own personal sippy cups from home. LPA’s observed all furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts.

At 9:35a.m. LPA Dunlap observed the parent sign in and out sheets. 1 out of 15 children were missing parent signature. A Technical Violation will be issued during todays visit.

There are 2 bathrooms with one toilet, one sink, one soap dispenser in each bathroom. Each bathroom has step stools for children to use for the sink. All electrical outlets in the bathroom were covered. Both sinks and toilets are in good working good condition. At 9:45a.m., LPA Dunlap observed in 2 classroom trash cans without a lid, and 2 bathroom trash cans without a lid Page 1 of 5

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398
VISIT DATE: 10/22/2024
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The outdoor area has wood chips covering the playground area where the slide structure is. There is a playhouse, picnic tables, toys, and bikes. There is a water fountain outside, but children do not use it. LPA’s observed all furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts.

At 10:00a.m., LPA Dunlap observed a trash can with no lid on the playground.

Cubbies are stored in the Parish hall and children nap in the classroom.

LPA Dunlap observed an operable smoke detector and carbon monoxide detector.

LPA Dunlap observed a fire extinguisher with 7/5/24.

LPA Dunlap observed a first aid kits with all required components.

At 11:00a.m. LPA Dunlap requested proof of Lead Testing for facility. The Acting Director presented paperwork, however the paperwork was not in compliance with regulations. The Acting Director was given information regarding Lead Testing and PIN 21-2.1-CP. This poses/posed a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited today.

LPA Chambers reviewed Staff Files

Staff #1

Files has all required licensing forms and immunization record.

CPR & First Aid- Exp 7/12/26

Mandated Child Abuse Reporter Certificate- Exp 10/24/24

Health & Safety Certificate in file. (717/24)

* Transcripts in evaluation process

This poses/posed a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited today.

Staff #2 -Staff file missing all required licensing documents, immunization records, and Mandated Child Abuse Reporter. Page 2 of 5

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398
VISIT DATE: 10/22/2024
NARRATIVE
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* Transcripts need to be evaluated

This poses/posed a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited today.

LPA Chambers reviewed Children Files

Child #1

All required licensing forms and immunization records in file.

Missing admission agreement.

Child #2

All required licensing form completed in file with the except the following:

LIC 613A- Blank

LIC995-Blank

Immunization's records are in file.

Missing admission agreement.

Child #3

All required licensing form completed in file with the except the following:

LIC700- Blank

LIC702- Blank

LIC 613A- Blank

LIC995-Blank

Missing admission agreement.

Immunization's records are in file. Page 3 of 5

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398
VISIT DATE: 10/22/2024
NARRATIVE
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Child #4
All required licensing forms and immunization records in file.

Missing admission agreement.


2 Children files missing LIC613A and 4 children files missing admission agreements This poses/posed a potential health, safety or personal rights risk to persons in care. Type B deficiency will be cited today.

The Acting Director stated they use a a landline as well as their personal cell phone.
The Acting Director stated they do not have any children that they administer medication to at this time.
The Acting Director stated that when children are in sick they are placed near the door of the classroom.
The Acting Director stated there are no firearms on the premises.
The Acting Director stated that there are no smokers on the premises nor smoking allowed.
The Acting Director stated that they do not provide transportation for children.

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.

Criminal Record Clearance - Child Care Centers Acting Director- Suzanne Wren 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.

Lead Testing

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398
VISIT DATE: 10/22/2024
NARRATIVE
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test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the Acting Director- Suzanne Wren shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

For the following scenarios use the below un-bolded language: • CCC COMPLETED TESTING AND IS IN PROCESS OF REMEDIATING LEAD EXCEEDANCES, or • CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE, or • CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE, or • CCC TESTING DEADLINE HAS NOT PAST LPA referred Acting Director- Suzanne Wren to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, a Plan for Providing 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: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org

Acting Director- Suzanne Wren 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.

Megan’s Law - Family Child Care Homes During the exit interview, the ACTING DIRECTOR- SUZANNE WREN****, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Appeal rights reviewed and given to the Acting Director Suzanne Wren

1 Technical Violation issued during todays inspection.

8 Type B deficiencies issued during todays inspection.

Exit interview conducted and report was reviewed with the Acting Director- Suzanne Wren Page 5 of 5

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
Page: 7 of 10
Document Has Been Signed on 10/22/2024 02:36 PM - It Cannot Be Edited


Created By: Keneisha Dunlap On 10/22/2024 at 01:31 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: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
WD
101700(b)
Written Directives for Lead Testing
(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in did not have current lead testing results available at the time of inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/22/2024
Plan of Correction
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The LPA provided acting Director with copy of PIN and information on how to obtain the lead lesting.
The acting Director will submit the required proof by POC date and submit results findings to LPA on or before POC date via email.
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above in 5 out 5 trash cans did not have lids which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/12/2024
Plan of Correction
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The acting director will purchase trash cans with lids for bathrooms, classroom, and playgrounds.
The acting Director will submit proof via email to LPA via email on or before POC date via email.
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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 10/22/2024 02:36 PM - It Cannot Be Edited


Created By: Keneisha Dunlap On 10/22/2024 at 01:31 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: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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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2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 2 files missing certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2024
Plan of Correction
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The Acting Director will have Staff #2 register and complete class by POC date.
The Acting Director will send proof to LPA via email by POC date
Acting Director will place updated certificate in Staff #2 file
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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2
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4
Based on record review, the licensee did not comply with the section cited above in 1 out of 2 files missing immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2024
Plan of Correction
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The Acting Director will have Staff #2 give copy of current immunizations.
The Acting Director will send proof to LPA via email by POC date
Acting Director will place updated certificate in Staff #2 file
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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 10/22/2024 02:36 PM - It Cannot Be Edited


Created By: Keneisha Dunlap On 10/22/2024 at 01:31 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: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 2 files missing Health Screening Report, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2024
Plan of Correction
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2
3
4
The Acting Director will have Staff #2 give copy or obtain health screening report.
The Acting Director will send proof to LPA via email by POC date
Acting Director will place updated certificate in Staff #2 file
Type B
Section Cited
CCR
101217(a)(12)
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: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 2 files missing TB Test results, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2024
Plan of Correction
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2
3
4
The Acting Director will have Staff #2 give copy or obtain TB test.
The Acting Director will send proof to LPA via email by POC date
Acting Director will place updated certificate in Staff #2 file
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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 10/22/2024 02:36 PM - It Cannot Be Edited


Created By: Keneisha Dunlap On 10/22/2024 at 01:31 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: ST. BARNABAS PRESCHOOL
FACILITY NUMBER: 198009398

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(6)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 4 out of 4 files missing admissions agreements, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2024
Plan of Correction
1
2
3
4
The Acting Director will have obtain admission agreements from admin office
The Acting Director will send proof to LPA via email by POC date
Acting Director will place all signed agreements in children files
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 out of 4 files missing LIC613A, which poses/posed a potential health, safety or personal rights risk to persons in care persons in care.
POC Due Date: 11/05/2024
Plan of Correction
1
2
3
4
The Acting Director will have parents fill out LIC613A
The Acting Director will send proof to LPA via email by POC date
Acting Director will place form LIC613A in children 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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/22/2024


LIC809 (FAS) - (06/04)
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