191606180-2-23-2023-54-CC-RNAO-CPBRBN-20230223115301

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191606180
Report Date: 02/23/2023
Date Signed: 02/23/2023 11:53:12 AM

Document Has Been Signed on 02/23/2023 11:53 AM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	BURSCH STATE PRESCHOOL		FACILITY NUMBER:	191606180
ADMINISTRATOR:	OWOAJE, FRNACISCA		FACILITY TYPE:	850
ADDRESS:	2505 W. 156 STREET		TELEPHONE:	(310) 898-6133
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY: 51	TOTAL ENROLLED CHILDREN: 51	CENSUS: 12	DATE:	02/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Melva Harrison-Teacher		TIME COMPLETED:	12:17 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An annual required unannounced site inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro on 02/23/2023. LPA Navarro arrived at the facility at 9:12am who met with Teacher Ms. Harrison.This is a Title 5 funded program. LPA toured the facility and visually inspected all areas of the center. The facility consist of a 1 room bungalow located on the grounds of Bursch Elementary School. The licensee operates two half day programs. AM Session 7:30am to 11:15am and PM Session: 11:15am to 3:00pm. Upon arrival LPA observed one teacher supervising 13 preschool children. Facility is in compliance with License capacity and Title Five ratio guidelines. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment. LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, LIC 613A- Notification of Personal Rights. All documents observed. Facility records were reviewed for LIC 9040- Facility Roster, Daily schedule and Disaster drill log, last drill conducted on February 2023. At 9:30 AM LPA toured Classroom #P1. Classroom had furniture in good condition, free of loose, sharp and/or pointed parts. Rugs were observed to lay flat on the ground to avoid tripping hazards. Water is made readily available by via operable filtered water fountain in the classroom. Children also bring water bottles from home that can be refilled freely. Per FR, there are currently no children with medication. Facility does not administer any medication. Ill Isolation area for a child waiting to be picked up is located at a table, away from the other chidlren. Children have cubbies to store personal belongings separate from each other. Per FR, children do not sleep at the facility because they are only present half day. There are no firearms or weapons on the premises.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BURSCH STATE PRESCHOOL	FACILITY NUMBER: 191606180
	VISIT DATE: 02/23/2023

NARRATIVE

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LPA toured the outdoor play area located outside of the classroom. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing structures to absorb fall. Shade was observed next to the playground in the outdoor area and water was observed to be readily available via water bottles. LPA did not observe hazards in the outdoor space.

LPA toured the children’s restrooms. Restrooms are located inside of the classroom. LPA observed two toilets and to sinks available inside of the classroom. Restrooms were observed to be safe and sanitary with operable sinks and toilets.

Breakfast for the AM session and Lunch for the PM session is provided by the Elementary School cafeteria. Food is not cooked at facility. Prepackaged food is brought from the neighboring, elementary school. Extra food is discarded after meals. Kitchen was observed to be clean, free of litter, insects and rodents. LPA observed trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food. Carbon Monoxide detector wired with smoke and fire alarm. At 10:15am, LPA asked FR if the classroom water has been tested for lead. Per FR, no lead testing has been completed.

LPA reviewed Sign In/Out sheets located at the classroom entrance. All children present were signed in with date, time and full signature of the child's representative.

Children’s records were reviewed at for Emergency Card, Immunization Records, Licensing Form (LIC) 627- Consent for Medical Treatment, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement.

Staff records were reviewed at 11:00 PM for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts or Permit and current Mandated Reporter Training Certificate.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BURSCH STATE PRESCHOOL	FACILITY NUMBER: 191606180
	VISIT DATE: 02/23/2023

NARRATIVE

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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA’s observations and records review, the following deficiency listed on the attached LIC 809D (deficiency page) is being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited needs to be cleared to protect the children’s health & safety.

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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Facility Representative Teacher Melva Henderson.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/23/2023 11:53 AM - It Cannot Be Edited

Created By: Raul Navarro On 02/23/2023 at 11:24 AM

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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BURSCH STATE PRESCHOOL	FACILITY NUMBER: 191606180
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Raul Navarro

LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC809 (FAS) - (06/04)

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