198020337-8-25-2021-33-CC-TRAO-C6929Y-20210825171242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020337
Report Date: 08/25/2021
Date Signed: 08/25/2021 05:12:57 PM

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:	SEGRAY EAGLE ROCK		FACILITY NUMBER:	198020337
ADMINISTRATOR:	STEVE HELLER		FACILITY TYPE:	850
ADDRESS:	4475 EAGLE ROCK BLVD.		TELEPHONE:	(323) 507-2640
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY:	155	CENSUS: 86	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Steve Heller/Annette Gladstone, Licensee		TIME COMPLETED:	12:30 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	Licensing Program Analysts (LPA) Thelma Razo and Licensing Program Manager (LPM) Brandi VanOosten conducted an unannounced Required – 1 Year inspection on 8/25/2021. LPA met with Licensee Steve Heller and Annette Gladstone and stated the purpose of the inspection. Licensees guided LPA and LPM on a tour of the facility. This is a preschool program which consists of 5 preschool classrooms and one toddler classroom (La Secouya). Center’s hours of operation is from Monday to Friday from 8:00 AM to 6:00 PM and is changed from 8AM-6PM to 8:30AM-5PM. The preschool program is on three separate buildings. There is currently a waiver on file and posted at the facility for a staggered outdoor play schedule for preschoolers and electronic registration system to sign the children in and out. All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Momiji 3 staff with 9 preschoolers; Sycamore: 3 Staff with 13 preschoolers; Wintergreen: 2 Staff with 20 preschoolers; Oak: 3 Staff with 18 preschoolers; Marula 2 staff with 13 preschoolers; and La Secuoya 3 staff with 13 toddlers. The facility was observed to be within the license capacity and limitations. The following was observed during the tour of the facility: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Napping equipment (cots) were observed in each classroom. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Area Supervisor states there are no poisons at the facility. Carbon monoxide detectors were observed and are operable. Page 1 of 3

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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 4

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: SEGRAY EAGLE ROCK	FACILITY NUMBER: 198020337
	VISIT DATE: 08/25/2021

NARRATIVE

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All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.
Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, and similar equipment are cushioned with material that absorbs a fall. Availability of outdoor drinking water was observed. LPA advised that no children shall be left without the supervision of a teacher at any time.
All floors were observed to me clean and safe. Al 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.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed. (Name, address, telephone of child’s authorized representative, Medical Assessment.) for completeness; 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 had proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof against TB, measles, pertussis, and influenza. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 2/4/2021. The facility provides morning and afternoon snacks and is posted.

First Aid supplies were observed in the classroom. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the office.

Medication: This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information
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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SEGRAY EAGLE ROCK	FACILITY NUMBER: 198020337
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/01/2021 Section Cited	1 2 3 4 5 6 7	Health-Health Services. Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement was not met as evidenced by: LPA observed Child #1's Epinephrine Injection did not come with the label direction as prescribed by physician and expired on
	8 9 10 11 12 13 14	May 2021. C1 is not present during this inspection. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SEGRAY EAGLE ROCK	FACILITY NUMBER: 198020337
	VISIT DATE: 08/25/2021

NARRATIVE

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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.

A deficiency was cited per California Code of Regulation, Title 22, Division 12 and is on LIC809-D.

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. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted and Appeal Rights provided.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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