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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020965
Report Date: 10/16/2024
Date Signed: 10/16/2024 12:02:27 PM

Document Has Been Signed on 10/16/2024 12:02 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DORRIS PLACE ELEMENTARYFACILITY NUMBER:
198020965
ADMINISTRATOR/
DIRECTOR:		ISMAEL BERVERFACILITY TYPE:
850
ADDRESS:2225 DORRIS PLACETELEPHONE:
(323) 222-9185
CITY:LOS ANGELESSTATE: CAZIP CODE:
90031
CAPACITY: 20TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
10/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Mr. Artiga Coordinator and Mrs. Martinez TeacherTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced annual random inspection. LPA met with Mr. Artija, Coordinator, who guided LPA on tour of facility. Teacher Gabriela Martinez took over the inspection once inside the classroom. This is an LAUSD state preschool program located in RM 11 on the premises of Dorris Place Elementary School. This program operates Monday through Friday 8:00 am to 2:30 pm. Per Teacher, there are 9 children enrolled.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Staff #1, #2 with 9 preschoolers. The following was observed during the tour of the facility:

PHYSICAL PLANT
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have store their belongings in their backpack. Per Teacher, the isolation area is located in the nurse’s office. In the nurse’s office a mat can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. LPA advised that there is a waiver on file to share the restroom with kindergarten, which should be posted. LPA observed that the facility has carbon monoxide detector which was tested and is in operable condition. General sanitation was observed. Availability of indoor drinking water was observed.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children in all areas. Teacher states that there are no poisons stored at the facility.


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DORRIS PLACE ELEMENTARY
FACILITY NUMBER: 198020965
VISIT DATE: 10/16/2024
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. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. There are no trash cans with tight fitting lids in the classroom. However, teacher states that trash is removed from the classroom right after meal times.

Outdoor playground equipment was observed. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. LPA advised that there is a waiver on file to share the yard with Kindergarten which must be posted.

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

Children’s Records were reviewed for completeness; Inspection of required forms was made. LPA Lopez issued the Children’s Record Review (LIC 857) to the Teacher during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

At 10:00 am LPA observed that children # 2-5 were missing the LIC 613a Personal Rights and the LIC 995 Parents rights on file. Additionally, children 2,3 and 5 were missing a physician report.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 9
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: DORRIS PLACE ELEMENTARY
FACILITY NUMBER: 198020965
VISIT DATE: 10/16/2024
NARRATIVE
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At 10:15 am Staff files were reviewed- LPA observed that staff # 2 is missing proof of current AB1207 mandated report training certificate. Certificate on file expired on 5/5/2024- per staff # 2 they have not taken a current training.

LPA will review complete staff files at a later time and date. If staff files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

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 10/2/2024.

LPA observed that food menus were posted. LPA advised that menus must be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Preschoolers are provided with breakfast and lunch by the Los Angeles Unified School District.

First Aid supplies were observed in the classroom hanging from an emergency disaster preparedness bag pack.

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 -------------------- pg. 3 of 5 ----------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 9
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: DORRIS PLACE ELEMENTARY
FACILITY NUMBER: 198020965
VISIT DATE: 10/16/2024
NARRATIVE
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(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). CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE

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 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.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DORRIS PLACE ELEMENTARY
FACILITY NUMBER: 198020965
VISIT DATE: 10/16/2024
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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 od 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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Facility Representative Gabriela Martinez and Mr. Artiaga.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 10/16/2024 12:02 PM - It Cannot Be Edited


Created By: Roxana Lopez On 10/16/2024 at 11:29 AM
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: DORRIS PLACE ELEMENTARY
FACILITY NUMBER: 198020965

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024

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
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Based on interview and record review, the licensee did not comply with the section cited above in that Staff # 2 did not have proof of current mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/16/2024
Plan of Correction
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Per lead teacher staff # 2 will take the training and certificate will be submitted to LPA by poc due date of 11/16/24
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that children 2-5 were missing a completed LIC 613a which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2024
Plan of Correction
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Per Lead Teacher they will provide forms to parents and add them to file- forms will be submitted to LPA for review by POC due date of 10/28/24
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
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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