Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405871
Report Date: 01/24/2017
Date Signed: 01/24/2017 03:54:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:SANTA MONICA-MALIBU USD/PINE STREET H.S./S.P.FACILITY NUMBER:
197405871
ADMINISTRATOR:ALICE CHUNGFACILITY TYPE:
850
ADDRESS:734 PINE STREETTELEPHONE:
(310) 399-5865
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:83CENSUS: 8DATE:
01/24/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Paris Williams, Teacher AssistantTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA), Tiffanie Tran conducted an unannounced annual/random visit. LPA met with Teacher Assistant, Paris Williams. Present were substitute teacher Paulina Levenson with 8 children. The main teacher is currently out for the day. LPA toured the facility and visually inspected all areas of the center.
The facility is located on the Elementary School ground utilizing only classroom #9 and #10. The facility consists of two sessions. All center staff had fingerprint cleared and associated to licensed facility. LPA observed proper care and supervision.
Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings, isolation area was inspected. Children do not nap at the facility because of a half day (3.5 hours) program. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. Trash can with tight lids, First Aid supplies, smoke detectors; carbon monoxide/fire extinguishers were observed. A review of medication policy, including administering, labeling, storage, and records was made. Sign in and out sheet procedures were reviewed. Menu was properly posted with all others posting requirements. All food items and snacks are delivered daily to the facility from the licensee main kitchen. Water is accessible indoor and outdoor by use of water fountains. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Director and teachers are currently certified in pediatric first aid and CPR.
Children's records were reviewed and in good order. Staff's files are located at the Licensees main office. A collateral visit will be arranged at another visit. The facility roster was up to date and emergency disaster drills were conducted on a monthly basis.
Incidental Medical Services were discussed. Currently the facility does not serve any children required IMS.
There was no deficiency found during today's visit, the facility was in substantial compliance of Title 22 Regulations at the time of the visit. An exit interview was conducted. The content of this report was read and discussed in detail at the time of with the noted contact person. Notice of site visit was posted upon received. For additional information visit our website at: www.ccld.ca.gov
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2017
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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