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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011002
Report Date: 05/27/2022
Date Signed: 05/27/2022 01:19:19 PM

Document Has Been Signed on 05/27/2022 01:19 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LOS ANGELES ADVENTIST ACADEMYFACILITY NUMBER:
198011002
ADMINISTRATOR:JACQUELINE GALBREATHFACILITY TYPE:
850
ADDRESS:846 E.EL SEGUNDO BOULEVARDTELEPHONE:
(323) 743-8818
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 40TOTAL ENROLLED CHILDREN: 18CENSUS: 8DATE:
05/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cassandra Hudson-Johnson, DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced annual inspection on 05/27/2022 at 9:00AM. LPA met with Cassandra Hudson-Johnson, Director, who guided analyst on a tour of the facility. This is a preschool program which consists of two classrooms; Classroom 1 and Classroom 2. Facility operation hours are Monday to Thursday 6:30 AM-6:00 PM, Friday from 6:30 AM to 4:30 PM.

All areas identified on the Facility Sketch were inspected. Upon arrival, there were 2 staff and 7 children. The facility was observed to be within the license capacity and limitations. Staff have received criminal record clearance. The facility has pending facility fees including late fees, LPA provided Director with fee printout and information needed to pay fees online at CDSS.CA.GOV.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have individual cubbies to store their belongings. Napping equipment (mats) were observed. Linens are taken home each week to be washed. Per Director, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms.

Disinfectants and cleaning solutions were in cabinets inaccessible to children. at 9:51am LPA observed that the cabinet located in the Director's office, where medication is stored, was not locked, this poses a potential risk to the children in care. The medication was observed to be labeled with child's name and date. First Aid kits are available in both classrooms.

Carbon monoxide detector was not available, posing a potential risk to the health and safety of children in care. The smoke detector was observed to be connected to the fire alarm. The 2A10BC fire extinguisher was observed in both classroom with the service tag indicating last inspected on 12/01/2020. Director was reminded that the Fire extinguisher needs to be serviced yearly. --------Page 1 - Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 05/27/2022
NARRATIVE
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Outdoor playground equipment is in a 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. There is adequate shade in the play yard. At 9:59pm LPA observed a large rusted toy chest and a large thorny plant in the children's play area (photo taken), this poses a potential risk to the health and safety of children in care.

The outdoor drinking fountain was observed to be inoperable. Per director, the classroom door is maintained open during outside playtime to allow children to freely go inside and drink water. LPA advised that no children shall be left without the supervision of a teacher at any time.

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. There are no pools or bodies of water at the facility.

Director was reminded that all adults 18 and over, 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 Child Care Center. 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.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857. Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. Children present were signed in.

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

Preschoolers bring their own food from home. The facility provides 2 snack if needed. LPA observed the children's lunch containers in children's individual cubbies.

The facility is following COVID-19 precautions and recommendations. LPA observed staff and children to wear mask while indoors.

Page 2 - Report continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 05/27/2022
NARRATIVE
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The Director was reminded to report unusual incidents.

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
LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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/tion-process

The following deficiencies listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.

Exit interview conducted with the Director Cassandra Hudson-Johnson. A notice of site visit was given and must remain posted for 30 days. Appeal Rights were discussed and a copy provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
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Document Has Been Signed on 05/27/2022 01:19 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 05/27/2022 at 11:59 AM
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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that there were no carbon monoxide detectors found in either of the classrooms which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/03/2022
Plan of Correction
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Per director, a carbon monoxide detector will be installed in the classroom and a picture will be sent to LPA email by POC due date.
Type B
Section Cited
CCR
101226(e)(1)(A)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (A) Medications shall be kept in a safe place inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observatio, the licensee did not comply with the section cited above due to medication is stored in a cabinet in the director's office that is not locked or latched which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/03/2022
Plan of Correction
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Per director, medication will be moved to locked cabinet or a safety lock will be placed on the cabinet, a photo of the correction will be sent to LPA's email by POC due date
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/27/2022 01:19 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 05/27/2022 at 11:59 AM
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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that an inhaler belonging to Child #1 did not have the box in with lable with prescription. The inhaler was placed in a ziplock bag with child's name and date written in sharpie which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/03/2022
Plan of Correction
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Per director, they will request the parent of child #1 to bring the original box where the inhaler came. A copy of the proof of correction will be sent to LPA's email by POC due date.
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above due to a large rusted chest and a large thorny plant was in the children's playarea, accessible to children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/03/2022
Plan of Correction
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Per licensee, the rusted chest and thorny plants will be removed and a photo of correction will be sent to LPA by POC due date
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022


LIC809 (FAS) - (06/04)
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