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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224698
Report Date: 05/09/2023
Date Signed: 05/09/2023 04:10:57 PM

Document Has Been Signed on 05/09/2023 04:10 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTENFACILITY NUMBER:
191224698
ADMINISTRATOR:STEPHANIA RASMUSSENFACILITY TYPE:
850
ADDRESS:7644 FARRALONE AVE.TELEPHONE:
(818) 340-6131
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 180TOTAL ENROLLED CHILDREN: 180CENSUS: 158DATE:
05/09/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:TIME COMPLETED:
04:25 PM
NARRATIVE
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On 05/09/23 at 9:04 AM, Antonio Almanza, Licensing Program Analyst (LPA), conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Stephania Ramussen , administrator and Elizabeth Orozco, Director and toured the facility. During today’s visit there are 159 children and 19 teachers. Days and hours of operation are Monday through Friday from 7:00 AM to 6:00 PM. LPA verified facility phone number is 818-340-6131.

The facility is located on the premises of Faith Baptist School, grades K-12. The preschool utilizes rooms 1,2,21,22,23,31,32, 33, and 52. All classrooms are equipped with first aid kit, telephone, pulldown fire alarm, smoke detectors and bathrooms. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked storage area. No poisons were observed during the inspection.

Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. The facility is free of flies, insects and rodents. Drinking water is available both indoors and outdoors.

The playground for the preschool is located in the back left corner of the facility on the other side of the Faith Baptist Schools playground. Areas around high climbing equipment, swings, and slides have cushioning material to absorb falls. All materials and surfaces accessible to children are toxic free.

Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Fire extinguishers in the facility were serviced on 10/05/2022.

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 05/09/2023 04:10 PM - It Cannot Be Edited


Created By: Antonio Almanza On 05/09/2023 at 02:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 5 out of 5 staff files reviewed do not have immuniations, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2023
Plan of Correction
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Facility agrees to get immunization recordsf or 5 staff by 05/19/23 and provide LPA a copy.
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that the Director and Person able to act on behave of the Director have not been reported to the child care office, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2023
Plan of Correction
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Facility agrees to provide notification via LIC308 designation of responsibility by 05/19/23, and provide LPA a copy.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Betty Bell
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023


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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698
VISIT DATE: 05/09/2023
NARRATIVE
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Director was reminded that prior to working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. No individuals excluded by the Department are allowed to be present. Staff 6 does not have a criminal Record Clearance on file was observed supervising children in room 32, and has been working at the facility since 2022. Capacity and limitations as specified on the license are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility. Director was reminded that children shall be under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. LPA reviewed a sample of staff files and observed files were complete with documentation of meeting qualification requirements and current documentation of completed mandated reporter training. Five of five staff files reviewed do not have immunization records for influenza, pertussis, and measles.

The Regional Office has identified Administrator Stephania Ramussen as the Director on file. The facility Director is Elizabeth Orozco who is reporting that she has been the Director since 2011. Administrator and Director are reporting that the Director is a classroom teacher and is scheduled to teach Monday through Friday during hours of operation. Facility does not have a current LIC 308 Designation of Responsibility on file for the Director or the name of the childcare center director or fully-qualified teacher(s) designated to act in the director’s absence. A clear written statement of the administrative responsibility and authority delegated to the child care center director has not been provided to the Director; A copy of this written statement shall be given to the childcare center director and shall be made available to the Department upon request.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process. page 2.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698
VISIT DATE: 05/09/2023
NARRATIVE
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The following 4 Type B and 1 type A deficiencies were cited during today's inspection (see LIC 809Ds), under California code of Regulations, Title 22, Division 12 & Chapter 1 and Health & Safety Code.


1. 101215.1(c) Child Care Center Directors Qualifications and Duties, The child care center director shall be responsible for the operation of the center, for compliance with regulations, and for communications with the Department; and has the authority to acknowledge receipt of deficiency notices and to correct deficiencies that constitute immediate threats to children's health and safety.
2. 101215.1(c)(1)(A) Child Care Center Directors Qualifications and Duties(1) There shall be a clear written statement of the administrative responsibility and authority delegated to the child care center director. (A) A copy of this written statement shall be given to the childcare center director and shall be made available to the Department upon request.
3. 101212(b) Reporting Requirements, The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
4. 1596.7995(a)(1) Standard (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
5. Type A: 101170(e) Criminal Record Clearance, All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. A Civil Penalty was assessed and LIC421BG was provided to the director.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Acopy of LIC 9224 was given to licensee.A copy of this Report, Notice of Site Visit, and Appeal Rights were explained and provided to Elizabeth Orosco, Director. Page 3
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Antonio Almanza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/09/2023 04:10 PM - It Cannot Be Edited


Created By: Antonio Almanza On 05/09/2023 at 02:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(c)
Child Care Center Directors Qualifications and Duties, The child care center director shall be responsible for the operation of the center, for compliance with regulations, and for communications with the Department; and has the authority to acknowledge receipt of deficiency notices and to correct deficiencies that constitute immediate threats to children's health and safety.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in tha the Director is an Assigned Classroom Teacher, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2023
Plan of Correction
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Facility will provide LPA written statement of what teacher will take over the Directors classroom in order for the Director to exercise their job duties and responsibilities as a Director by 05/12/23.
Type B
Section Cited
CCR
101215.1(c)(1)(A)
Child Care Center Directors Qualifications and Duties(1) There shall be a clear written statement of the administrative responsibility and authority delegated to the child care center director. (A) A copy of this written statement shall be given to the childcare center director and shall be made available to the Department upon request.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that the the Director was not provided a clear written statement of the administrative responsibility and authority delegated to the director, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/12/2023
Plan of Correction
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Facility will provide Director package and LIC308 for Director and Person able to act on behave of the Director.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Betty Bell
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023


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Document Has Been Signed on 05/09/2023 04:10 PM - It Cannot Be Edited


Created By: Antonio Almanza On 05/09/2023 at 03:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: FAITH BAPTIST SCHOOL - FOUR-YEAR KINDERGARTEN
FACILITY NUMBER: 191224698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)
Criminal Record Clearance, All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, LPA observed Staff 6 providing care and supervision to children in room 32, does not have a criminal record clearacne on file and has been working at facility since 2022, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/10/2023
Plan of Correction
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Facility will not allow staff 6 back until she has received a criminal record clearance and is associated to the facility. Staff 6 will need to get a new LiveScan because staff was last associated to a facility on March 2019.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Betty Bell
LICENSING EVALUATOR NAME:Antonio Almanza
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023


LIC809 (FAS) - (06/04)
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