198017093-9-19-2023-33-CC-VMGA-CVU2FD-20230919172119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017093
Report Date: 09/19/2023
Date Signed: 09/19/2023 05:21:27 PM

Document Has Been Signed on 09/19/2023 05:21 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 CC RO, 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:	(424) 426-7094
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90065
CAPACITY: 150	TOTAL ENROLLED CHILDREN: 118	CENSUS: 85	DATE:	09/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lucita Gil		TIME COMPLETED:	05:35 PM

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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced 1-year required inspection at the above facility on 09/19/23 at 02:00 p.m. A COVID-19 risk assessment was conducted prior to entering the facility inspection at this facility. LPA met with Lucita Gil, Director who guided LPA on a tour of the facility. The program currently operates Monday, Wednesday, Thursday, and Friday from 02:30 p.m. - 06:00 p.m. and Tuesday from 01:30 p.m. - 06:00 p.m. Per the Director, there are 121 children enrolled. The program operates on the premises of Mt. Washington Elementary School.

All areas identified on the facility sketch were inspected. Currently the program operates in rooms: 4, 5, and 6. Rooms 2 and 9 are currently not in use. LPA observed 85 children with 07 staff. Teacher-child ratios were observed to be in accordance with Title 22 school age regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times.

Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the school's nurses office is used as an isolation area. There is a cot available.

LPA observed required forms to be posted on the Parent Board located near entrance of the facility. LPA observed the following: Facility License, Snack Menus, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed, last drill was conducted on 08/17/23. LPA observed activity scheduled posted.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MT. WASHINGTON STAR	FACILITY NUMBER: 198017093
	VISIT DATE: 09/19/2023

NARRATIVE

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Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides snacks via the "Supper program" offered by the school district. There is drinking water available indoor and outdoors via water jugs and disposable cups. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The licensee takes measures to keep the facility free of flies, other insects and rodents.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Director states there are no weapons or firearms on the premises.

Sign in and out sheets were reviewed to ensure that procedures are in accordance with Title 22 requirements. Staff sign in all children whom are enrolled.

Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 995 Notification of Parent’s Rights, and LIC 627 Consent for Emergency Medical Treatment. LPA observed all children’s records to be complete.

Staff Records were reviewed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights.

SB792 Immunization Requirements for Staff and Employees was discussed. Staff have required documentation on file.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. Staff 1 (S1) and S7 do not have a current Mandated Reporter Training.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MT. WASHINGTON STAR	FACILITY NUMBER: 198017093
	VISIT DATE: 09/19/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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.

Licensee 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.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview conducted and report was reviewed with Director Lucita Gil and appeal rights were provided.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/19/2023 05:21 PM - It Cannot Be Edited

Created By: Veronica Martinez-Garza On 09/19/2023 at 05:06 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MT. WASHINGTON STAR	FACILITY NUMBER: 198017093
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/19/2023

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
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in Staff 1 and Staff 2 did not have a current Mandated Reporter Training, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/26/2023
	Plan of Correction
1 2 3 4	Per Director, she will submit proof of training to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ana Chico

LICENSING EVALUATOR NAME:

Veronica Martinez-Garza

LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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