191870887-2-4-2022-54-CC-DGIS-CBBTJA-20220204134601

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870887
Report Date: 02/04/2022
Date Signed: 02/04/2022 01:46:36 PM

Document Has Been Signed on 02/04/2022 01:46 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	NORMANDIE AVENUE EARLY EDUCATION CENTER		FACILITY NUMBER:	191870887
ADMINISTRATOR:	RAUL MORENO		FACILITY TYPE:	850
ADDRESS:	4407 RAYMOND AVENUE		TELEPHONE:	(323) 292-0266
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY: 118	TOTAL ENROLLED CHILDREN: 60	CENSUS: 41	DATE:	02/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Raul Moreno, Facility Representative		TIME COMPLETED:	02:00 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 Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 2/4/22 at 9:30 AM. LPA met with Raul Moreno, Facility Representative (FR) who guided analysts on a tour of the facility. There were 41 children and 13 staff present when LPA arrived. Facility capacity is in compliance 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 with the Los Angeles Unified School District. At 9:40AM LPA toured the classrooms. LPA observed classroom #1, 2A, 2B and #3. Furniture was in good condition, free of loose, sharp and pointed parts. All outlets were covered. Floors were safe and clean. No cleaning supplies are stored in the classrooms. Each classroom has a first aid backpack hanging near a door. There were toys and age appropriate material for children. Toys and material were free of loose, sharp and pointed parts. LPA observed that children have individual cubbies where their personal items are stored. Cots for napping were observed in each classroom. Classroom #1 has a water dispenser and children bring their own water bottles. Facility has extra water bottles on hand. Classroom 2A and 2B use a pitcher and cups/water bottles and classroom #3 has a water fountain. All water is readily available for children. Per observation and interview, there are currently no children with medication at this time. At 10:00AM LPA toured three children's restrooms. Currently one restroom is assigned to a specific classroom to minimize the spread of COVID-19. Restrooms were operable and sanitary. At 10:15AM LPA toured the outdoor play area. The outdoor activity space is fee of hazards. There were age appropriate toys and material, free of loose, sharp and or pointed parts. LPA observed a water fountain and water dispenser readily available for children. Shaded areas were observed in multiple parts of the yard. LPA observed required cushioning under the climbing structures to absorb fall. ------------------page 1

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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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Document Has Been Signed on 02/04/2022 01:46 PM - It Cannot Be Edited

Created By: Denise Gibbs On 02/04/2022 at 12:53 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NORMANDIE AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870887
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/04/2022

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
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 14 out of 14 staff files which poses/posede a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2022
	Plan of Correction
1 2 3 4	Per FR staff will bring in proof of immunization and he will email proof to LPA by 3/4/22

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:

Trevino Cochran

LICENSING EVALUATOR NAME:

Denise Gibbs

LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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: NORMANDIE AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870887
	VISIT DATE: 02/04/2022

NARRATIVE

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At 10:10AM LPA observed and tested required Carbon Monoxide detector. Device is operable.

At 10:20AM LPA reviewed Sign In/Out sheets located in the main office. All children present were signed in with date, time and full signature of the Teacher who accepts the child. Due to COVID-19 precautions parents do not enter the facility. A digital daily pass (approved child health assessment) is scanned and the child is dropped off. In order to limit the amount of contact and the spread of COVID-19, one teacher handles the sign in clipboard and pen.

At 10:30AM LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Parent’s Rights and Lunch/Snack Menu.

At 10:45 LPA toured the kitchen located adjacent to the main office. Facility provides AM and PM snack and lunch. Food is not cooked at the facility. Prepackaged food is brought from the neighboring, elementary school. Extra food is stored in the kitchen. Kitchen was observed to be clean, free of litter, insects and rodents. LPA observed trash cans for solid waste have tight fitting lids.

At 11:00AM Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 2/3/2022.

Children’s records were reviewed at 11:30AM 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. 10 out of 10 records were complete.

Staff records were reviewed at 11:45AM for approved Pediatric First Aid and CPR certification, proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, Transcripts or Permit and current Mandated Reporter Training Certificate. LPA observed that 14 out 14 files were missing staff immunization records.

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. ------------------page 2

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

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: NORMANDIE AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870887
	VISIT DATE: 02/04/2022

NARRATIVE

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LPA observed that licensee is implementing COVID-19 precautions and procedures.

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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)/ (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 deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need 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.

Facility representative was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home.

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, Raul Moreno.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022

LIC809 (FAS) - (06/04)

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