198400620-8-15-2022-54-CC-TTRN-CHBV2X-20220815160352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400620
Report Date: 08/15/2022
Date Signed: 08/15/2022 04:04:04 PM

Document Has Been Signed on 08/15/2022 04:04 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:	CII/STANFORD HEAD START		FACILITY NUMBER:	198400620
ADMINISTRATOR:	JUSTINE LAWRENCE		FACILITY TYPE:	850
ADDRESS:	706 E. MANCHESTER AVE		TELEPHONE:	(323) 905-1042
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90002
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/15/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Justine Lawrence		TIME COMPLETED:	04:20 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	About 1:00PM. Licensing Program Analyst (LPA), T. Tran met with facility representatives Justine Lawrence, Vice President and Monica Olivo, Site Supervisor for the purpose of an announced pre-licensing visit. Application documents were reviewed; licensee has submitted all needed documents. The fire inspector has approved the capacity of 32 preschoolers and 16 toddlers for the total capacity of 48 children. LPA toured and measured the facility indoor and outdoor. The facility had sufficient indoor, outdoor space with toilets and sinks to accommodate the 32 preschooler children and 16 toddlers. The facility is utilizing building C, D, & E to operate preschool with toddler program. (Bld. E-Infant license 198400616 is on the premises) The hours of operation from 8:00AM – 4:30PM; Monday-Friday. LPA observed an operating telephone in the Child Care Center, 2:10 ABC fire extinguisher, carbon monoxide detectors are located in the hallway area and in the classroom area, smoke detector alarms are located in the classroom. Outdoor equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. Play area does not have any hazards or bodies of water. Inspection of the outdoor play area was conducted. There were two separated outdoor play yards with proper shade. Drinking water is readily available indoor and outdoor by the use of water dispenser and disposable cups. Fencing around the perimeter of the play area is at least 4 feet high. Playground is free from miscellaneous debris such as tree branches, trash, leaves, etc. Children Bathrooms: Each toddler classroom equipped with 1 toilet with a double sinks and a changing table. Preschool children had separated restroom with 2 toilets and a double sinks by the hallway. Furniture/Equipment/Toys/Books: Facility has napping cots for children in care. Facility representative is reminded that should children nap there must be a sheet and blanket available for the children to use. Children shall not sleep on a bare cot. Cots must be sanitized daily after use. Classrooms were equipped with age appropriate furniture/toys/equipment and were clean and orderly. All trash cans in the classrooms has lids on. Page 1-4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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: CII/STANFORD HEAD START	FACILITY NUMBER: 198400620
	VISIT DATE: 08/15/2022

NARRATIVE

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Staff Bathroom: The staff bathroom is located inside site supervisor's office and another on near the kitchen area. Children shall not have access or use the staff bathroom. Facility is to ensure that proper ratios are always maintained when staffs need to leave to go to the rest-room area.
Kitchen/ Food Preparation area/Lunches: Food preparation area will not be accessible to children in care. Snack Menu are to be posted for parents to view. Food preparation area is adequately equipped with sink, was clean and free from hazards. Cleaning supplies shall be kept out of reach of children and will be stored separately and away from food. There is hot and cold running water in the kitchen/food preparation area. Refrigerator is clean and operating at the proper temperatures. Trash cans have lids
Required Postings/Licensee shall have posted in the Child Care Center at all time the following:
Facility license.
Personal Rights form (LIC 613A).
Menus.
Child passenger restraint system poster. (PUB 269).
Daily activity schedule.
Emergency Disaster Plan (LIC 610) and Earthquake Preparedness Checklist (LIC 9148).
Parent’s Rights Poster (PUB 393).
Notice of Site Visit (LIC 9213).
Any licensing report documenting a type “A” citation must be posted for 30 days.
Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type A deficiency must be posted for 30 days
Medication Administration/Incidental Medical Services:
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
Children's Records are to be maintained by the facility and must contain the following:
Identification and Emergency Information - Child Care Centers (LIC 700).
Child's Preadmission Health History - Parents’ Report (LIC 702).
Child's Preadmission Health Evaluation if not enrolled in a public or private elementary school - Physician's
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

LIC809 (FAS) - (06/04)

Page: 4 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CII/STANFORD HEAD START	FACILITY NUMBER: 198400620
	VISIT DATE: 08/15/2022

NARRATIVE

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Report (LIC 701).
Consent for Medical Treatment (LIC 627).
Written statement from parent(s) or authorized representative exempting child from medical assessment, immunization, and treatment because of adherence to a religious faith that practices healing by prayer or other spiritual means; or physician's statement that immunization is not indicated.
California School Immunization Records (“blue cards”, PM 286) for non-school-age children.
Current Admission Agreement, with authorized signature(s).
Centrally Stored Medication and Destruction Record (LIC 622), if medications are handled.
Documentation of unusual behavior or signs of illness, special needs.
Unusual Incident/Injury Report (LIC 624).
Signed and dated receipt of Notification of Parents’ Rights (LIC 995).
Personal Rights — Community Care Facilities, Child Care Facilities (LIC 613A) receipts, signed and dated.
Authorizations for dispensing medication, signed by each child’s authorized representative.
Documentation required for health-related services, if needed (e.g., blood-glucose monitoring and nebulizer care).(LIC 9166). Gastrostomy Tube Care: Physician’s Checklist (LIC 701A). Acknowledgement of receipt of licensing reports (LIC 9224), if applicable.
Licensee shall maintain Administrative Records which shall have the following:
Written inspection procedures for accepting children on a daily basis.
Sign-in/sign-out sheets kept for current 30 days, or approved waiver to use electronic pin system.
Admission policies, including admission criteria, ages of children who will be accepted; medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any.
Designation of Facility Responsibility (LIC 308).
Personnel Report (LIC 500) showing current roster.
Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months. Documentation of drills shall be maintained for at least one year.
Up-to-date list of qualified teacher substitutes.
Documentation of exceptions and waivers: Facility Waiver Request (LIC 956) and Exception/Exemption Request (LIC 971).

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CII/STANFORD HEAD START	FACILITY NUMBER: 198400620
	VISIT DATE: 08/15/2022

NARRATIVE

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Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). And a Child Care Facility Roster (LIC 9040).
The applicant was advised to access the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes, and especially the Quarterly Updates.
The licensee was informed about the Healthy Schools Act and the required training to be completed.
Senate Bill 792 was discussed pertaining the requirement of immunization for staff working at child care
LPA informed the effects of lead exposure for children between ages 1-6 years old are the most at risk for lead poisoning. A copy of lead exposure was provided.
Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Licensee is reminded that smoking is prohibited on the premises.
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.

No deficiency was cited during today's visit. A notice of site visit was given and must remain posted for 30 days.

Effective 08/15/22, facility will be granted to serve for 32 Preschool children with 16 Toddlers for the total capacity of 48 children.

Exit interview conducted and report was reviewed with the facility representative, Justine Lawrence.

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

LIC809 (FAS) - (06/04)

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