Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493531
Report Date: 08/14/2017
Date Signed: 08/15/2017 02:51:06 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:RIVERSIDE STARFACILITY NUMBER:
197493531
ADMINISTRATOR:GONZALES, ANGELOFACILITY TYPE:
840
ADDRESS:13061 RIVERSIDE DRIVETELEPHONE:
(310) 842-8040
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY:60CENSUS: 0DATE:
08/14/2017
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Amy SmithTIME COMPLETED:
12:48 PM
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LPA Majarian conducted pre licensing visit at Riverside Drive Elementary school for the purpose of Pre licensing Star after-school program. LPA met with Amy Smith, Director of program. The STAR program will run an after-school program for the students of the elementary site. STAR is requesting a capacity of 60 children. The program will operate from 2:30pm to 6pm Monday thru Friday, except Tuesday 1:00 pm 6:00 pm.

For purposes of sign in/out, the program sign the child in and the parents will be issued a ticket for retrieval of their child. The parent has to present the ticket to staff in order to sign the child out of the program. The indoor (classrooms) and outdoor (play yard) will not be measured as the program is located on an existing school site.

The program will utilize 2 of the bungalow classrooms located at the back of the school, Room 27 and 28. First Aid supplies were inventoried. Each classroom has one sink and one fountain. The program will offer snack for the children. Snack/menus were reviewed. Food and snacks were checked for availability, quantity and appropriateness to children in care. There is no food preparation areas since it is only snack. LPA observed empty container for left over of crackers or cereal. LPA observed all storage containers for solid waste with tight-fitting covers and that they are kept on, and in good repair. LPA observed all areas that are accessible to the children were toxic free and director was advised to take measures to keep the facility free of flies, other insects and rodents.

The children will utilize the restrooms on campus, girls and boys will have separate restrooms. Ms. Smith will double check if it will be exclusive use for the children in this program.
Furniture and equipment is in good condition and is free of loose pointed parts. The children have access to the playground but do not access the area while elementary school children (children who are not part of the program) are on the yard. There are no pools or bodies of water in the facility.
SUPERVISOR'S NAME: Carla CaldwellTELEPHONE: (951) 337-4351
LICENSING EVALUATOR NAME: Victoria MajarianTELEPHONE: (310) 337-4367
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


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: RIVERSIDE STAR
FACILITY NUMBER: 197493531
VISIT DATE: 08/14/2017
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LPA observed age appropriate sinks and toilets for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. LPA inspected the heating, lighting and ventilation of the site/classrooms. Due to the age of the children in care, they do not nap. However, LPA was told that they will have some mats in case younger children will want to rest or take a nap. LPA observed appropriate storage for the children's belongings. Disinfectants, cleaning solutions and other items that are dangerous to the children, are inaccessible to the children in care, they are located under the sink which was latched. LPA advised all storage areas with poisons shall be locked at all times. Medication will be housed in the after-school bungalows, as well as, the elementary office, however there are procedures (Title 22) that will be followed prior to administering the medication. Medication shall be inaccessible to the children. LPA reminded applicant of the requirements for criminal records/child abuse index clearances, child abuse reporting, inspection authority, and capacity limitations. Applicant was also reminded of incident/medication documentation. Applicant was provided the Departments website: www. ccld.ca.gov. LPA will send applicant a children's form packet.

Ms. Smith informed LPA that presently at this site no children will be needing any special services which falls under IMS; however, the program provides services in other sides.
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

The Department will issue provisional license for 60 days for the capacity of 60. However, prior to the the following has to be done: 1) The items on top of the cabinets should be removed to ensure safety of the children.

The Department will issue permenant license after conducting final reveiw of the file and ensuring all the necessary documentation is in the file.

809 was issued and copy of this report was provided.
SUPERVISOR'S NAME: Carla CaldwellTELEPHONE: (951) 337-4351
LICENSING EVALUATOR NAME: Victoria MajarianTELEPHONE: (310) 337-4367
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2