198017093-7-22-2021-33-CC-CGRN-C56RRP-20210722131528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017093
Report Date: 07/22/2021
Date Signed: 07/22/2021 01:15:34 PM

Document Has Been Signed on 07/22/2021 01:15 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MT. WASHINGTON STAR		FACILITY NUMBER:	198017093
ADMINISTRATOR:	AUTUMN BARNES		FACILITY TYPE:	840
ADDRESS:	3981 SAN RAFAEL DRIVE		TELEPHONE:	(323) 223-2714
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90065
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/22/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Lucita Gil		TIME COMPLETED:	01:30 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	An announced case management- licensee initiated site inspection was conducted today by Licensing Program Analyst (LPA) Crystal Green. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Licensing staff met with Director, Lucita Gil, who guided analyst on a tour of the facility. This is a school age program currently licensed for 60 children which will operate from 2:00 PM – 6:00 PM Monday through Friday. The licensee is requesting a capacity increase adding 2 rooms to the existing license. The program operates on the premises of Mt. Washington Elementary School. At 11:30 AM, Licensing staff was guided through a tour of the facility both indoors and outdoors. The facility is currently closed as a COVID-19 precautionary measure no children were observed during this inspection. This program is currently utilizing 3 classrooms; Room 4, 5, and 6. LPA inspected Room 2 and Room 9. Play equipment, furniture and restrooms were inspected for appropriateness. Each class room was observed to be spacious and furnished with age appropriate furniture, equipment and supplies. Classrooms are centrally heated and air conditioned. Lighting is provided by windows and overhead lighting. Children will use the elementary school's restrooms. Postings related COVID-19 were observed posted throughout the facility. Due to COVID- 19 precautionary measures, Check-in will take place at the entrance of the facility outside the main office door were temperature and wellness checks will be conducted. The designated isolation area will be the Directors Office located in the front entrance of the school site (2nd room on left). Parents will be called immediately if children become sick. Ill children will use the staff restroom. The facility will serve afternoon snacks. Food storage for snacks will be kept in the director’s office area. Children use the elementary school playground which offers room for a variety of outdoor sports and games. Required shade was observed outdoors. Elementary playground restrooms will be used by children. No transportation will be conducted by the facility. Report Continues Page 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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 2

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MT. WASHINGTON STAR	FACILITY NUMBER: 198017093
	VISIT DATE: 07/22/2021

NARRATIVE

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This facility plans to provide Incidental Medical Services- IMS. For IMS information, see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS was 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

During this inspection, the classrooms and outdoor play areas were not measured as program operates on school grounds which is exempt from required square footage and required sinks and toilets. School-age child care programs that meet the requirements of Health and Safety Code Section 1596.806 are exempt from square-footage requirements for indoor activity space.

The final approval of licensee request for a capacity increase to 150 is pending receipt of an approved Fire Clearance.

Exit interview was conducted with Director Lucita Gil, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

Report Ends Page 2 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2