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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019526
Report Date: 03/14/2023
Date Signed: 03/14/2023 05:00:14 PM

Document Has Been Signed on 03/14/2023 05:00 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:FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOLFACILITY NUMBER:
198019526
ADMINISTRATOR:ADALINA HERRERAFACILITY TYPE:
850
ADDRESS:10700 S. SAN PEDRO STTELEPHONE:
(323) 756-1975
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 15TOTAL ENROLLED CHILDREN: 19CENSUS: 13DATE:
03/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 AM
MET WITH:Angela Huffman, LicenseeTIME COMPLETED:
05:20 PM
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Licensing Program Analysts (LPA) Denise Gibbs and Susann Sanchez conducted an unannounced annual required inspection at the above facility on 3/14/23 at 12:00 PM. LPAs were initially met by Jasmine Smith, Facility Representative (FR). Licensee Angela Huffman arrived to facility during inspection.

This is a preschool program with a toddler option, which consists of one classroom. Per licensee the gate intended to separate the toddler option was taken down. LPA's observed toddlers commingling with preschool children. LPAs also observed a 17 month old child in care upon arrival, which is a violation of the license. LPAs also observed Staff (S) 1 and S2 caring for children upon arrival. S1 and S2 do not have child development units and are not qualified teachers.

Per Licensee facility operation hours are 24 hours but currently children are present from 7am to 8pm, Monday to Friday. There were 13 children and four staff present when inspection began. LPAs observed that Staff Four (S4) is cleared but not associated to the facility, which is a potential hazard.

LPAs toured the classroom. Classroom had furniture in good condition, free of loose, sharp and/or pointed parts. LPAs observed two carpets in the classroom with stains and debris. Per staff, children have access to the water dispenser in the kitchen area. Staff brought out a pitcher of water for the children. LPAs did not observe cups for the children to drink freely. LPAs observed hazards in the classroom including: all purpose cleaner on the floor next to the staff table accessible to children, a full can of Green Sheen interior/exterior paint on the floor next to the storage cabinet, accessible to children, hand sanitizer with the children's toys, staff's personal items (purses) with the children's toys, phone cord chargers plugged in and hanging from the wall, and exposed outlets. Per FR, there are children with diagnosed asthma and allergies but parents do not provide medication. Medication storage was discussed with Licensee. Children have cubbies to store personal belongings separate from each other. LPA observed children have matts for napping. Blankets are provided and washed by the
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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526
VISIT DATE: 03/14/2023
NARRATIVE
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facility. LPAs observed nap time and children are not provided sheets to cover their matts. Per FR there are sheet, they are being washed. Required water lead resting for Child Care Centers has not been completed. PIN 21-21.1-CCP was provided.

LPAs toured the children’s restroom. Facility does not have a separate restroom for the toddler option and no waiver is on file for shared restroom. A wall pull down changing table was observed in the restroom. Restroom was observed to be safe and sanitary with two operable toilets. Restroom is accessed through the kitchen area. Children's hand washing sink is outside the restroom in the kitchen.

LPA observed the outdoor area. The outdoor area was observed to have age appropriate toys and material for children. Outdoor area was not set up do to weather. Shade was observed throughout the outdoor area. LPAs did not observe a separate outdoor area for the toddler option. There is no waiver on file for shared outdoor space. The following hazards were observed outdoors; the chain link fence that separates the neighboring property is bent upward along the bottom creating sharp edges accessible to children, rusted and broken chairs, handles on bikes are missing rubber creating sharp edges, gate covering is not secured and falling creating access to blind spots, the side passage next to the outdoor shed was observe to have broken fencing, paper goods and debris on the ground and high chairs were observed to be stained.

LPAs observed required posted documentation in the facility entrance, which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, and LIC 613A- Notification of Personal Rights. Food menu was observed accessible to parents through the Bright Wheel application, but was not posted in the classroom.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 2/3/23. All documents were observed. First aid kit was available. Items needed for first aid kit were discussed.

Sign in/out is done electronically via Bright Wheel. A QR code is scanned and documents the time of sign in and sign out. FR printed sign in/out sheets for the day. LPAs observed that staff are signing children in and out instead of parents. All children present were signed in with date and time.

LPA toured the kitchen. Facility provides Breakfast, AM Snack, Lunch and PM snack. Food is not cooked that the facility. ----------------------PAGE 2
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526
VISIT DATE: 03/14/2023
NARRATIVE
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Prepared food is delivered daily to the facility. Kitchen was observed to have a refrigerator to store food. LPA's observed mold in the freezer (no food was observed in the freezer). Children's snack were observed in a high cabinet, stored with Lysol and Bleach. Bleach and Fabuloso was observed in a low cabinet in the kitchen accessible to children. Trash cans for solid waste have tight fitting lids. Dual smoke and carbon monoxide detector is located outside the kitchen in the classroom and is operable.

Children’s records were reviewed for Licensing Form (LIC) 700 Emergency Card, Immunization Records, LIC 627- Consent for Medical Treatment, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. Three out of 13 children are missing full files, 9 out of 13 children are missing immunization records, 11 out of 11 children are missing physicians reports.

Staff records were reviewed for approved Pediatric First Aid and CPR certification for at least one staff member on site, LIC 9052- Employee Rights, LIC 501- Personnel Record, LIC 503- Health Screening Report, LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts and current Mandated Reporter Training Certificate. Two out of four staff are missing Mandated Reporter and immunization's. Four out of four staff are missing health screenings.

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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)/ (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

FR was provided with the information for CCL Technical Support Program.

Based on the LPA’s observations and records review, 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 & safety. ---------------PAGE 3
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526
VISIT DATE: 03/14/2023
NARRATIVE
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A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent.

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 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 civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

Exit interview conducted and report was reviewed with the Facility Representative, Christian Seymour.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
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Page: 4 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
1
2
3
4
Per FR they will remove all hazardous items, child proof the cabinets in the kitchen and email a picture to LPA by POC date 3/15/23. Outlets were covered during inspection.
Licensee will be scheduled for a Regional Office meeting to discuss deficiencies.
Type A
Section Cited
CCR
101238.4(d)
Storage Space
(d) Combustibles, cleaning equipment and cleaning agents shall be stored in an area separate from food supplies in a locked cabinet or in a location inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the licensee did not comply with the section cited above. LPAs observed cleaning products in the kitchen cabinet with children's food, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
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2
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4
Cleaning supplies removed during inspection
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


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Page: 5 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Outdoor Activity Space
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
3
4
Type A
Section Cited
CCR
101216.3(b)(1)
Teacher-Child Ratio
(b) The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. (1) A ratio of one fully qualified teacher (as specified in Section 101216.1(c) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).

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. S1 and S1 were observed caring for children. Staff do not have child development units, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
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2
3
4
Per FR, She will be the opening teacher, she is qualified. FR will email an update LIC500 to LPA by POC date 3/15/23
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 6 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101216.4(a)(2)
Preschool Program with Toddler Component
(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children. Space planning and usage for the toddler component shall be governed by the provisions of Section 101438.3. Plans to alternate use of outdoor play space must be approved by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. Toddler activity space, toddler restroom and outdoor space are not separate from preschool program, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
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2
3
4
Per licensee, she will put up the gate that sectioned off the toddler area tomorrow and email a picture to LPA by POC date 3/15/23. Licensee will also submit a waiver for shared restroom and outdoor space.
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 7 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.1(c)
Napping Equipment
(c) Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. Children are not provided sheets to cover nap mats, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR she will get sheet out of the dryer for tomorrows nap time. FR will send a picture to LPA by POC date 4/14/23
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above. Licensee has not completed required lead testing, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR, they will read the lead test PIN and plan accordingly. Documentation will be sent to LPA by POC date 4/14/23.
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 8 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 out of 4 staff files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR , she will get immunization records for staff and email them to LPA by POC date 4/14/23
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 record review and interview, the licensee did not comply with the section cited above in 2 out of 4 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR, the two staff member missing the training will complete it and she will email certificates by POC date 4/14/23
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 9 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101170(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above. Staff 4 is cleared but not associated to the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
1
2
3
4
Per FR, she will submit the transfer form, ID and LIC 508 for staff to the RO for association
Type B
Section Cited
CCR
101215.1(f)
Child Care Center Director Qualifications and Duties
(f) When the child care center director is absent from the center, arrangements shall be made for a fully qualified teacher as specified in Section 101216.1(c) to act as substitute. This substitute child care center director shall be aware of center operations, including total enrollment; shall be trained in program operation; and shall be designated as an authorized person to correct operational deficiencies that constitute immediate threats to children's health and safety.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above. Director is missing LIC 308 and CCL Orientation Step 2, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR, she has completed Step one and Step 2 for child care centers and she will have licensee fill out LIC308 for her. LPA will be emailed copied of forms by POC date 4/14/23
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 10 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 4 out of 4 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR all staff will get a health screening done and forms will be emailed to LPA by POC date 4/14/23
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 11 out of 11 staff files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR she will email parents a new health screening form and asked them to have it filled out by physician. LPA will be emails copies for all children missing the forms by POC date 4/14/23
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 11 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(a)
Immunizations
(a) Prior to admission to a child care center, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, commencing with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 9 out of 13 children's files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
FR will communicate with parents and email LPA copies of immunization records for children by POC date 4/14/23
Type B
Section Cited
CCR
101221(a)
Child's Records
(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 13 children files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
FR will communicate with guardian and have them fill out the enrollment packet and email LPA packets by POC date 4/14/23
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 12 of 22
Document Has Been Signed on 03/14/2023 05:00 PM - It Cannot Be Edited


Created By: Susann Sanchez On 03/14/2023 at 01:24 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: FULL GOSPEL CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 198019526

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

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. Staff is signing in and signing out children instead of the person who brings and removes the child, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2023
Plan of Correction
1
2
3
4
Per FR parents are being notified that they need to use the Bright Wheel app to sign children in and out. If parents do not have the app a paper sign in and out sheet will be provided. sign in/out sheet for 3/15 will be email to LPA by POC date 3/15/23
Type B
Section Cited
CCR
101216.4(a)(1)
Preschool Program with Toddler Component
(1) A child who is between 18 months and 36 months of age may participate in the toddler program with written permission from the child's authorized representative. No child in the toddler program shall be placed in the preschool program before the age of 30 months without written permission from the child's authorized representative.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in two toddler files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
1
2
3
4
Per FR, she will create a form and give it to Toddler parents. FR will email form for toddlers enrolled to LPA by POC date 4/14/23
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:Valarie Cook
LICENSING EVALUATOR NAME:Susann Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023


LIC809 (FAS) - (06/04)
Page: 13 of 22