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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011002
Report Date: 08/27/2024
Date Signed: 08/27/2024 04:39:57 PM

Document Has Been Signed on 08/27/2024 04:39 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LOS ANGELES ADVENTIST ACADEMYFACILITY NUMBER:
198011002
ADMINISTRATOR/
DIRECTOR:		CASSANDRA HUDSON-JOHNSONFACILITY TYPE:
850
ADDRESS:846 E.EL SEGUNDO BOULEVARDTELEPHONE:
(323) 743-8818
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 16DATE:
08/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cassandra Hudson-JohnsonTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On August 27, 2024, Licensing Program Analysts (LPAs) V. Wheatley and Devon Carus conducted an Annual inspection. LPAs entered the main entrance of the school and was met by the Registrar Ms. Hunt. Ms. Hunt then lead the LPAs to the preschool classrooms which are on the west side of the campus. LPAs met director Cassandra Hudson-Johnson and observed 16 children present today. The children were also supervised by Teacher Zipporah Thomas. The parents enter through a side gate and come inside the facility to drop off their children.

LPAs toured the preschool classrooms. The facility is open Monday through Thursday from 6:30am to 6PM and Friday 6:30am to 4:30pm. There is no swimming pool 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.

The side gate is locked when children are playing outside. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. LPA observed and inspected all playground equipment. The director removed a container with sharp edges off the playground. The surface of the outdoor activity space is maintained and is free of hazards. Areas around high climbing equipment, slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. All toilets and hand washing faucets are in safe and sanitary operating condition. Facility has a functioning carbon monoxide an smoke detectors that meet statutory requirements. The children bring their own lunch for now however the main school will be providing lunch in the future for those parents who request it. Snack menu was observed. The food preparation area is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The children use their own labeled water bottles and the staff provide bottled water.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002
VISIT DATE: 08/27/2024
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Prior to working or volunteering in a licensed child care facility, all individuals are subject to a criminal record review and have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Capacity and limitations as specified on the license are being maintained. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence has been reported to the Department.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care.

LPAs reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete and current documentation of CPR/first aid is current for the director and teacher. The completed Mandated Reporter Training was observed for director but not teacher.

Incidental Medical Services (IMS) are being provided. Director states there are no children enrolled receiving IMS and understands that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPAs discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, Type B deficiencies are cited. An exit interview was conducted, a copy of this report was provided to the Director. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
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Document Has Been Signed on 08/27/2024 04:39 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 08/27/2024 at 12:44 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: LOS ANGELES ADVENTIST ACADEMY
FACILITY NUMBER: 198011002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation and record review, the licensee did not comply with the section cited above in that during the record review the director's health screening report was not in the file. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2024
Plan of Correction
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The director will complete the heatlh screening form and provide to the doctor to complete with signature showing the director is in good health and TB test recorded.
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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Based on the LPA's observation and record review, the licensee did not comply with the section cited above in that there is no record in the file of a TB test for the director. This is required and poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2024
Plan of Correction
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The director will complete the heatlh screening form and provide to the doctor to complete with signature showing the director is in good health and TB test recorded.
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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024


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