Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405871
Report Date: 04/10/2018
Date Signed: 04/10/2018 01:30:45 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:
3103995865
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:83CENSUS: 10DATE:
04/10/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Melinda Rodriguez, TeacherTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Tiffanie Tran arrived at the above facility to conduct an annual random inspection. LPA met with Melinda Rodriguez, teacher and toured all areas accessible to children. Upon arrival, children were in the process of vision screening. LPA observed proper care and supervision during this inspection. All center staff that was present during today’s visit had fingerprint cleared and associated to the designated license number.
The premises consist of 4 classes; currently only one class is operating. Facility hours of operation are 8:30am - 3:30pm Monday - Friday. The facility serves 2 half-day sessions AM and PM. There is no extended care offered. LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, Activity Schedule. The facility obtained current pediatric CPR and First Aid for all facility staff members. Children Records were reviewed. Staff records located in the main office. LPA will arrange another visit to review staff records at the main office. Per staff stated, all staff at this site have completed the mandated reporter online training.
During this inspection, LPA observed a working telephone on the premises, heating, lighting and ventilation were evaluated. Furniture and equipment were inspected for age appropriateness and good repair. No napping equipment were observed due to half day operation. Adequate storage for children's belongings, bathrooms facilities, and separate area for isolation and care of ill children located in the class in the quiet area. Availability of drinking water was observed with cups and water dispenser. Documentation of current Fire/Earthquake disaster drill was observed. First Aid supplies were inventoried and available. Sign in/out were observed. A review of medication policy, including properly labeled and stored in original container. During today’s inspection, per center staff stated there were two children with asthma.
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
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2018
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: SANTA MONICA-MALIBU USD/PINE STREET H.S./S.P.
FACILITY NUMBER: 197405871
VISIT DATE: 04/10/2018
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This facility only offer snack. Snacks were delivered from the school district daily. An inspection of cleaning and food supply storage areas was made. Snack items are properly stored. Outdoor area observed to be fenced. Climbing structure, slides and apparatus equipment securely anchored and has cushioned with material that absorbs falls zone. Bikes were observed in good condition. LPA observed other educational materials were available for children to utilize. Play area observed free of miscellaneous debris or hazards and inaccessibility to bodies of water. Required shade and rest areas are provided, water fountain observed available and accessible to children.
LPA reminded that it is the facility responsibility to know the regulations as well as anyone who assists in providing care. Site supervisor was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.cdss.ca.gov. LPA also 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. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Facility may also register on CCAP website for the new quarterly report to be notified. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541 Email Address: childcareadvocatesprogram@dss.ca.gov Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. Website: www.mandatedreporterca.com

Facility was found to be in substantial compliance at the time of the site inspection.

Exit interview was conducted and copy of report was discussed and given to the noted person.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2018
LIC809 (FAS) - (06/04)
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