191870741-6-28-2023-58-CC-LHEZ-CT8T9Z-20230628143245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870741
Report Date: 06/28/2023
Date Signed: 06/28/2023 02:32:54 PM

Document Has Been Signed on 06/28/2023 02:32 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:	HAWAIIAN AVENUE EARLY EDUCATION CENTER		FACILITY NUMBER:	191870741
ADMINISTRATOR:	AGUET, DEBORAH		FACILITY TYPE:	850
ADDRESS:	501 HAWAIIAN AVE.		TELEPHONE:	3108347186
CITY:	WILMINGTON	STATE: CA	ZIP CODE:	90744
CAPACITY: 117	TOTAL ENROLLED CHILDREN: 117	CENSUS: 51	DATE:	06/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Raquel Sheppard, Principal		TIME COMPLETED:	02:45 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	Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual inspection to the above facility on 06/28/2023. LPA arrived at the facility at 09:35AM, identified self and met with Raquel Sheppard, Principal, who guided analyst on a tour of the facility. LPA provided the principal with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is a state preschool program. Hours of operation are Monday – Friday, 7:00AM – 5:30PM There were 51 children and 16 staff present when LPA arrived. All individual’s present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. The following was observed during the tour of the facility: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. Children have their own cubby to store their belongings. Cots and linens are provided for each child enrolled. Linens are washed weekly by school district. Age-appropriate sinks and toilets were inspected for availability and good repair in the restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. LPA observed cleaning solutions in cabinet inaccessible to children. Disaster drill log was available, last drill was conducted on 05/29/2023. Carbon monoxide detectors were observed in the classrooms. IQ Air Filtration Technology installed has built in carbon monoxide detector. This system was installed due to refineries located near the facility. PAGE 01 of 04

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HAWAIIAN AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870741
	VISIT DATE: 06/28/2023

NARRATIVE

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LPA observed menus posted. Menus for the past 30 days are available upon request. The facility provides breakfast to children in AM session and lunch to the children in the PM session. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.

Outdoor playground equipment is in a 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 areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. Availability of outdoor drinking water was observed. LPA observed drinking outlets to be labeled as filtered water. Per principal, all sources of drinking water have new fixtures and water filter systems. LPA advised that no children shall be left without the supervision of a teacher at any time.

All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free. Per principal, there are no firearms stored on the premises. LPA did not observe pools or bodies of water at the facility.

LPA observe at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC857.

Staff records were reviewed. 5 out of the 5 records reviewed were incomplete. Missing documentation was documented on the LIC859.

LPA observed First Aid supplies in the classroom. ----PAGE 02 of 04

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HAWAIIAN AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870741
	VISIT DATE: 06/28/2023

NARRATIVE

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Per principal, medication is only administered to a child when accompanied with a doctor's note and is stored in the main office. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the staff lounge.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: LPA provided the principal with a copy of the Effects of Lead Exposure form during the inspection and discussed the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: HAWAIIAN AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870741
	VISIT DATE: 06/28/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.
Principal Sheppard was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on the LPA's observations and records review no deficiencies will be cited today 6/28/2023.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Raquel Sheppard, Principal.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/28/2023 02:32 PM - It Cannot Be Edited

Created By: Lilia Hernandez On 06/28/2023 at 02:08 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: HAWAIIAN AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870741
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 5 out of the 5 personnel records reviewed were incomplete which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Per Principal, a copies of missing records will be emailed to LPA and will be submitted by POC due date.

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:

Rita Ramos

LICENSING EVALUATOR NAME:

Lilia Hernandez

LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023

LIC809 (FAS) - (06/04)

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