198400855-12-6-2023-54-CC-TTRN-CY9RQ5-20231206121259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400855
Report Date: 12/06/2023
Date Signed: 12/06/2023 12:13:31 PM

Document Has Been Signed on 12/06/2023 12:13 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MAOF HEAD START/EARLY HEAD START-TELEGRAPH		FACILITY NUMBER:	198400855
ADMINISTRATOR:	GUERRERO, SONIA		FACILITY TYPE:	830
ADDRESS:	4447/4457 TELEGRAPH ROAD		TELEPHONE:	(323) 263-9507
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90023
CAPACITY: 13	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	12/06/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Cynthia Rodriguez		TIME COMPLETED:	12:40 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 (LPAs) T. Tran and A. Padilla made an announced prelicensing visit. About 10:30 AM, LPA met with Educator Coordinator, Cynthia Rodriguez, who provided a tour of the facility. Applicant applying for a capacity of 12 infants. The hours of operation are Monday-Friday; 6:30 A.M. through 5:30 P.M, Monday through Friday. The fire inspector has approved for the above capacity requested. The facility had sufficient indoor, outdoor space with toilets and sinks to accommodate the 12 infants. This location also serve preschool/toddler license 191870869. Each component has its own separate physical space for indoor and outdoor. LPA inspected and measured all areas specified on the facility sketch. The sleeping area for infants was separated by a half wall from the indoor activity space. LPA observed 6 cribs that met the United States Consumer Product Safety Commission safety standards. LPA observed a sink in this room within arm's reach of the changing table. There is age-appropriate furniture and equipment observed in the classroom which appear to be in new condition. Age- appropriate sinks and toilets are available for children to use in the classroom. There is dispensable soap and paper towels in the bathroom. Cubbies are available for children's belongings. Napping equipment (cots) were observed in the toddler classroom. The facility provides breakfast, lunch, and snack. All hot meal items are cook here at the site. Facility shall ensure that food is age appropriate and follows Federal Food Guidelines. Kitchen area includes a refrigerator, a sink has running water. Cabinets are available for storage and free from cleaning compounds. Parents of the Infant children in care provide the bottles. Bottles are labeled with the children's names, dated, and properly stored. The staff's space will be used by ill children with a foldable playpen. The staff restroom will be the designated restroom for ill children. First aid supplies are available. Carbon monoxide detectors and smoke detectors are present and in operable condition. Fire extinguisher (2A-10BC) was fully charged. Page 1/4

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAOF HEAD START/EARLY HEAD START-TELEGRAPH	FACILITY NUMBER: 198400855
	VISIT DATE: 12/06/2023

NARRATIVE

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Outdoor physical space is completely fenced. Playground equipment is in safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is outside shade in the play area. The facility state that there are no bodies of water on the premises and none were observed during this visit.
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
LPA discussed an individual infant sleeping plan shall completed for each infant up to 12 months of age. Licensee must physically check on the sleeping infant(s) every 15 minutes and document the condition of the infant(s). In addition, LPA provided the safe sleep for baby pamphlet. Each infant shall always be constantly supervised and under direct visual observation by an adult person. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep-related causes of infant death.
LPA recommended facility director to stay updated with information related to Covid-19 from the California Department of Public Health (CDPH) guidelines, including Centers for Disease Control and Prevention (CDC) guidelines to help prevent and protect staff and children in care. LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations and PINs. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.
LPA informed of released PIN 21-15 CCLD related to Kidde Trusense Smoke & combination Smoke/Carbon
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.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAOF HEAD START/EARLY HEAD START-TELEGRAPH	FACILITY NUMBER: 198400855
	VISIT DATE: 12/06/2023

NARRATIVE

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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).
Sudden Infant Death Syndrome, Shaken Baby Syndrome Poster.
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
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 Report (LIC 701).
Consent for Medical Treatment (LIC 627).
Written statement from parent(s) or authorized representative exempting child from medical assessment, immunizations, 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.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MAOF HEAD START/EARLY HEAD START-TELEGRAPH	FACILITY NUMBER: 198400855
	VISIT DATE: 12/06/2023

NARRATIVE

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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).
Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). And a Childcare 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 childcare.

The license will be granted for infant license with the capacity of 12 children.

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

Exit interview conducted and report was reviewed with facility representative, Cynthia Rodriguez.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC809 (FAS) - (06/04)

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