198017132-6-17-2025-33-CC-RLOZ-DHQU8H-20250617152134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017132
Report Date: 06/17/2025
Date Signed: 06/17/2025 03:21:44 PM

Document Has Been Signed on 06/17/2025 03:21 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:	4TH STREET EARLY EDUCATION CENTER		FACILITY NUMBER:	198017132
ADMINISTRATOR/ DIRECTOR:	IRENE SANTILLAN		FACILITY TYPE:	850
ADDRESS:	421 S. HILLVIEW AVENUE		TELEPHONE:	(323) 266-4024
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90022
CAPACITY: 144	TOTAL ENROLLED CHILDREN: 126	CENSUS: 89	DATE:	06/17/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:10 PM
MET WITH:	Principal, Kathy Romo		TIME VISIT/ INSPECTION COMPLETED:	03:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced Annual Random Inspection. LPA met with Principal, Kathy Romo, who guided LPA on a tour of the facility. This is a state preschool program operated by LAUSD located on the premises of 4^th Street Elementary School. This program consists of 6 classrooms; RM1, RM2, RM3, RM4, RM5 and RM6. Facility operation hours are Monday through Friday from 7:00AM to 5:30PM. This facility has a capacity of 144 children; per Director there is 126 children enrolled.

Upon arrival, the following staff were present during this inspection: RM1: Staff #1, #2, #3 and #4 with 16 napping preschoolers; RM 2: Staff # 5 and #5, #6 and #7 with 13 napping preschoolers, RM3: Staff #8, #9 and #10 with 14 napping preschoolers; RM 4: Staff #11 and # 12 with 19 napping children; RM 5: Staff #13, #14 and #15 with 19 napping preschoolers and RM 6: Staff #16, #17 and #18 with 6 napping children. Teacher-child ratio is met. All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment with the Los Angeles Unified School District. All children were observed to be under visual supervision of a teacher at all times.

LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. --------------- pg. 1 of 4-------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 4TH STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 198017132
	VISIT DATE: 06/17/2025

NARRATIVE

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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 staff lounge is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Food menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Preschoolers are provided with Breakfast, Lunch and PM Snack by the Los Angeles Unified School District. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. Per Principal, children bring their water bottles from home and water is provided if needed. 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. Principal, states that there are no poisons stored at the facility.

Facility has one functioning carbon monoxide detector that meets statutory requirements. The carbon monoxide detector is located inside the staff lounge. 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. There is adequate shade in the play yard. The Principal states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit.

Sign in and out sheets were reviewed by LPA to ensure that children who are present where sign in. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file.

Staff Records were reviewed to ensure that personnel records are maintained on all staff. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.---- pg. 2 of 4--

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

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: 4TH STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 198017132
	VISIT DATE: 06/17/2025

NARRATIVE

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SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

At 2:15 pm LPA observed that staff # 2 is missing current AB1207 Mandated Child Abuse Reporting On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

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/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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

Facility Representative was informed of the MyChildCarePlan.org website; a

consumer education website that helps families obtain child care by connecting them to child care
------------------------------------------------- pg. 3 of 4 ---------------------------------------------------------------------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

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: 4TH STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 198017132
	VISIT DATE: 06/17/2025

NARRATIVE

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providers and Resource and Referral Agencies (R&Rs) throughout California.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.m 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.

Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Kathy Romo.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Roxana Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/17/2025 03:21 PM - It Cannot Be Edited

Created By: Roxana Lopez On 06/17/2025 at 02:52 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: 4TH STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 198017132
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2025

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, interview and record review, the licensee did not comply with the section cited above in that Staff # 2 does not have current mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/17/2025
	Plan of Correction
1 2 3 4	Per Principal, they will have staff # 2 complete the certificate and submit to LPA by POC due date of 7/17/25

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.

	Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:

	Roxana Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025

LIC809 (FAS) - (06/04)

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