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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019203
Report Date: 02/11/2022
Date Signed: 02/11/2022 12:29:52 PM

Document Has Been Signed on 02/11/2022 12:29 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:ROOSEVELT HEAD STARTFACILITY NUMBER:
198019203
ADMINISTRATOR:LA TUNYA FISHERFACILITY TYPE:
850
ADDRESS:1574 LINDEN AVETELEPHONE:
(562) 218-1164
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 24TOTAL ENROLLED CHILDREN: 22CENSUS: 13DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Patricia L. Castro & Natasha JacksonTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced required 1 year inspection to the above facility on 02/11/22. Upon arrival LPA met with Patricia Lopez Castro, Head Teacher who informed LPA that children were going outdoors for outdoor play time. There were 3 staff with 13 children upon arrival. This facility is located within Roosevelt Elementary School in the city of Long Beach. COVID-19 precautionary measures were observed. LPA was later met by Natasha Jackson, Early Learning Center Manager.

At approximately 9:12AM LPA singularly toured the outdoor playground due to staff and children playing outdoors and staff providing supervision. LPA observed two tricycles with missing handles. LPA inquired about the missing handles and was informed by staff that the handles on the tricycles have been missing for 6 months even though a work order has been submitted. Outdoor play structure was inspected for age appropriateness, safety, cushioned material to absorb a fall, and good repair. Shade, drinking water and fencing were inspected. At approximately 9:22AM LPA observed that all children were escorted to a school age restroom. The restroom is not part of the licensed space for children to use and the department had not received any previous notification of the facility using the school age restroom for preschool children nor is there a waiver request from the facility therefore no approval from the department. In addition, there is no sign on the restroom door indicating that preschool children will utilize the school age restroom.

This is a preschool program that has 1 classroom Room A105. The facility operates to part-day sessions from Monday through Friday. The AM session operates from 7:45AM to 11:15AM and the PM session operates from 12:15PM to 3:45PM. Staff #1, Staff #2, and Staff #3 were present with 13 children.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings. Children at this facility do not nap due to part-day enrollment. ----Page 1 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROOSEVELT HEAD START
FACILITY NUMBER: 198019203
VISIT DATE: 02/11/2022
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Availability of drinking water was observed indoors. Appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, and general sanitation. First Aid supplies were observed. Disinfectants, cleaning solutions, medication and other dangerous items to children, were inaccessible. Head Teacher states that there are no poisons stored at the facility. Carbon monoxide detectors were observed and tested to ensure that they are operable.

Menus were posted. This facility has all meals and snacks delivered. Children in the AM session are provided a full breakfast and children from the PM session are provided with a full lunch.


A review of medication policy, including administering, labeling, storage, and records were made.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Teacher child ratios were observed, and staff names recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate. Sign in and out sheets were reviewed, and procedures were discussed with staff. Personal Rights of children were discussed and observed by LPA.

All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. There are no firearms stored on the premises. There are no pools or bodies of water at the facility.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions. ---Page 2 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROOSEVELT HEAD START
FACILITY NUMBER: 198019203
VISIT DATE: 02/11/2022
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Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 01/25/22.

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

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.

The following deficiency listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.

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

Exit interview conducted and report was reviewed with the Early Learning Center Manager, Natasha Jackson.

------Page 3 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/11/2022 12:29 PM - It Cannot Be Edited


Created By: Rita Ramos On 02/11/2022 at 12:00 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ROOSEVELT HEAD START
FACILITY NUMBER: 198019203

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101175(a)
101175(a) Waivers and Exceptions for Program Flexibility

(a) Unless the licensee receives prior written departmental approval for a waiver...the licensee shall maintain continuous compliance with all licensing regulations.

This requirement is not met as evidenced by:

LPA observing that the facility has preschool children utilize a school age restroom without departmental approval or a waiver permitting the use of the school age restroom. The restroom is not part of the license approval.
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above due to LPA observing that the facility has preschool children utilize a school age restroom without departmental approval or a waiver permitting the use of the school age restroom. The restroom is not part of the license approval which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2022
Plan of Correction
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Per Early Learning Center Manager, the facility will no longer use the school age restroom and a procedure outlining how the facility will ensure that the school age restroom will no longer be used will be submitted by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Trevino Cochran
LICENSING EVALUATOR NAME:Rita Ramos
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2022


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