Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019499
Report Date: 11/13/2017
Date Signed: 11/13/2017 04:28:22 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PLAY PRESCHOOLFACILITY NUMBER:
198019499
ADMINISTRATOR:GABRIEL ROSSFACILITY TYPE:
830
ADDRESS:2828 GLENDALE BLVDTELEPHONE:
(323) 664-8494
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:20CENSUS: 0DATE:
11/13/2017
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Gabriel RossTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Judy Mora and Licensing Program Manager (LPM) Katherine Harewood met with Gabriel Ross (owner) for Play Preschool who guided licensing staff on a tour of the facility. This is a secondary pre-licensing inspection. The purpose of this visit is to discuss issues of missing paperwork and to determine who the Director of the facility will be.

Applicant also has a family child care license, Ross Family Child Care LIC#198019323, which is located directly next door to the child care facility. Applicant was advised that he could not be the Director of the preschool and the owner of the family child care at the same time. Applicant was advised that he could surrender his license for the family child care home or hire a qualified Director. Applicant stated that he would surrender his family child care license if he could not find a qualified Director. Applicant was advised that he had until 11/28/17 to submit new required paperwork for Director of the preschool or the family child care license. The following documentation must be submitted for the Director: LIC 501, LIC 503, LIC 508, LIC 9052, LIC 9108, Criminal Record Clearance, verification of educational documentation, Pediatric CPR and Health and Safety. The Applicant was advised that he was sent the Notice of Incomplete Application was sent to him on 08/28/17 and had 30 days to submit the missing paperwork. As of today, not all missing items have been submitted.

During this inspection, licensing staff observed that since the initial pre-licensing inspection changes had been made to the facility and are still being made. Construction was visibly being done during this visit. Applicant was provided with 04 LIC 404, Financial Information and Release Verification. Applicant was also advised that his LIC 503 Health Screening Report had not been submitted.

*REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
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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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PLAY PRESCHOOL
FACILITY NUMBER: 198019499
VISIT DATE: 11/13/2017
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Applicant was advised that the Parent Handbook needed to be modified to meet the program description of care for infants including a needs and services plan.

Licensing staff observed that the applicant had 10 pack and plays in the infant napping area and 04 emergency evacuation cribs. Applicant was advised that pack and plays cannot be used for infant napping and was told to remove the items. Applicant was advised that cribs need to be placed in the napping room.

On 11/06/17, Applicant was advised that the infant playground needed to be resurfaced and shade needed to installed. As of today, the infant playground has not yet been finished and the shade has not been installed.

Based on previous report for inspection conducted on 11/06/17, on line 21, indicates that there was a Koala horizontal changing table located in the staff restroom and was within an arms reach of a sink. However, during this inspection, LPA Mora observed that there was no changing table in the staff restroom and a changing table was observed on the floor, to be installed.

Exit interview conducted with Gabriel Ross. Appeal rights and procedures explained and provided.



*END OF REPORT
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
LIC809 (FAS) - (06/04)
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