198400108-9-13-2022-54-CC-DGIS-CJ8QMC-20220913121719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400108
Report Date: 09/13/2022
Date Signed: 09/13/2022 12:17:29 PM

Document Has Been Signed on 09/13/2022 12:17 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:	JOHN TRACY CENTER		FACILITY NUMBER:	198400108
ADMINISTRATOR:	CATHLEEN MATHES		FACILITY TYPE:	850
ADDRESS:	2160 WEST ADAMS BLVD		TELEPHONE:	(213) 748-5481
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 11	DATE:	09/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cathleen Mathes, Facility Representative		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) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 9/13/22 at 9:00 AM. LPA met with Cathleen Mathes, Facility Representative (FR) who guided analysts on a tour of the facility. This is a preschool program which consists of two classrooms (Big Room and Small Room). All children were combined in the Big Room classroom today due to staffing and low numbers. Facility operation hours are Monday-Thursday 9:00AM-3:00PM and Friday 9:00AM- 12:00PM. There were 11 children and six staff present when LPA arrived. Facility is in compliance with license capacity and Title 22 ratio guidelines. All individuals present have obtained a criminal record clearance. LPA toured both classrooms. Classrooms had furniture in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. LPA observed that rugs were flat on the ground to avoid tripping hazards. Water is made readily available via water bottles. Water pitchers were observed in the classroom refrigerators to refill water bottles. Per FR, children’s medication is currently being stored at the facility. Medication is stored in the administration office, inaccessible to children in care. Medication was reviewed for proper storage, required documentation and expiration date. Children have hooks to store personal belongings separate from each other. LPA observed children have mats for napping. Mat sheets are provided by facility and washed every Friday or as needed. Families provides blankets and take them home to wash every Friday. First aid kits were observed in each classroom. LPA toured the children’s restrooms. One restroom was observed in each classroom. Restrooms were observed to be safe and sanitary with operable sinks and toilets. ---------------------PAGE 1

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/13/2022

NARRATIVE

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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Based on the LPA's observations and records review no deficiencies will be cited today 9/13/22.

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 Bridgette Klaus Facility Representative, .

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: JOHN TRACY CENTER	FACILITY NUMBER: 198400108
	VISIT DATE: 09/13/2022

NARRATIVE

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LPA observed the outdoor play area. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. Shade was observed throughout the outdoor area. Children’s water bottles are taken outdoors and placed in an area where they are freely accessible. One restroom is accessible from the outdoor area. Restroom was observed to be safe and sanitary.

LPA observed required posted documentation outside of the classrooms, 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 and AM/PM snack Menu. All documents were observed.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 8/19/22. All documents were observed.

Sign in/out sheets are located outside of the classroom. All children present were signed in with date and time. Due to COVID-19 precautions, parents are dropping off outside the facility and not handling the sign In/Out sheets. Teacher’s are signing children in/out during drop off and pick up. Staff was reminded that at the time of drop off the staff receiving the child must sign with their full signature and when the child is released to their guardian the staff must sign with their full signature.

Facility stores AM and PM snack in refrigerators in the classroom. Kitchen area on second floor is not used for children's food preparation. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less. Per FR, carbon monoxide detector is wired with smoke detector and file alarm system.

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. All documents complete.

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. All documents were observed. ----------------------PAGE 2

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2022

LIC809 (FAS) - (06/04)

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