198017019-8-26-2022-54-CC-DGIS-CHNU3W-20220826151414

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017019
Report Date: 08/26/2022
Date Signed: 08/26/2022 03:14:33 PM

Document Has Been Signed on 08/26/2022 03:14 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:	ESCUTIA PRIMARY CENTER CSPP		FACILITY NUMBER:	198017019
ADMINISTRATOR:	PATRICIA PONCE		FACILITY TYPE:	850
ADDRESS:	6401 BEAR AVENUE ROOM K-1		TELEPHONE:	(323) 585-8237
CITY:	BELL	STATE: CA	ZIP CODE:	90201
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 11	DATE:	08/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Patricia Ponce, Facility Representative		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 3/26/22 at 12:00PM. LPA met with Patricia Ponce, Facility Representative (FR) who guided analysts on a tour of the facility. There were 11 children and one staff and one adult present when LPA arrived. This is a preschool program that operates two sessions, AM-8:00AM-11:00AM and PM-11:40AM-2:40PM. Facility is on the campus of Escutia Primary Center in Room K-1. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. LPA toured Classroom K-1. Classroom furniture was in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. Rugs were observed to be flat on the ground to avoid tripping hazards. Water is made readily available via water bottles brought from home and provided by facility. LPA observed extra water bottles on hand in the classroom. Water fountains in the classrooms are not being used due to COVID-19 precautions. Children have cubbies to store personal belongings. Children do not nap at the facility due the part time schedule. Per FR there is currently one child with medication. LPA reviewed medication storage, expiration date and documentation. Carbon monoxide detector is wired with the facility smoke/fire alarm. LPA toured the children’s restroom. LPA observed a waiver on file for shared restroom. Preschool shares restroom with UTK. LPA reminded classroom teacher that the UTK program cannot be in the restroom when the preschool children are in there. Restrooms were observed to be safe and sanitary with operable sinks and toilets. LPA toured the outdoor play area. Outdoor area was observed to have age appropriate toys and material for ---------------------PAGE 1

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: ESCUTIA PRIMARY CENTER CSPP	FACILITY NUMBER: 198017019
	VISIT DATE: 08/26/2022

NARRATIVE

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children, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing structure to absorb fall. Shade was observed in the outdoor area and water was observed to be readily available via water bottles. Outdoor water fountains are being used. Outdoor area is also used by the UTK program. Per FR, children are not out at the same time. Waiver on file for staggered play outdoors. LPA observed Preschool children eating lunch at the lunch tables outside of the Preschool yard with other elementary children. Preschool children were sitting at their own table, being supervised under Title 5 guidelines. LPA discussed co-mingling with FR. FR will ask district director about obtaining waiver for meal time.

LPA reviewed Sign In/Out sheets. All children present were signed in with the time, date and guardian's full signature.

LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, PUB 269- Child Passenger Restraint System, Licensing Form (LIC) 613A- Notification of Personal Rights, Daily Schedule and Lunch/Snack Menu in the preschool classroom. Menu was discussed, per FR Menu is available online through the Yum Yumi app, available for parents. Parents are not entering facility do to COVID-19 precautions.

Facility records were reviewed for LIC9148- Earthquake Preparedness form, LIC9040- Children's Roster and (LIC) 610- Facility Disaster Plan. Disaster drill was last drill conducted June 2022 before summer break and next fire drill is scheduled for 8/31/22.

Children’s records were reviewed for Emergency Card with signed medical consent, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All documents were observed.

Staff records were reviewed at for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, Transcripts or Permit and current Mandated Reporter Training Certificate. Mandated Reporter missing, staff could not log into account. ----------------------PAGE 2

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: ESCUTIA PRIMARY CENTER CSPP	FACILITY NUMBER: 198017019
	VISIT DATE: 08/26/2022

NARRATIVE

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LPA observed the kitchen located on the elementary campus. Facility provides Breakfast and Lunch. Food is not cooked at the facility. Prepackaged food is delivered daily. Extra food is discarded daily. Kitchen was observed to be clean, free of litter, insects and rodents. All trash cans have tight fitting lids for solid waste. Cleaning supplies are stored separate from the food.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment. LPA observed that facility is implementing COVID-19 precautions and procedures as required by Los Angeles Unified School District and the Department of Public Health.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPA 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 the LPA's observations and records review no deficiencies will be cited today 8/26/22.

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

Exit interview conducted and report was reviewed with the Facility Representatives, Patricia PONCE -----------------PAGE 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: ESCUTIA PRIMARY CENTER CSPP	FACILITY NUMBER: 198017019
	VISIT DATE: 08/26/2022

NARRATIVE

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

Exit interview conducted and report was reviewed with the Facility Representatives, Patricia Ponce.

---------------------PAGE 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

LIC809 (FAS) - (06/04)

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