192005044-12-9-2021-54-CC-RRAS-C9JSD6-20211209124636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192005044
Report Date: 12/09/2021
Date Signed: 12/09/2021 12:46:46 PM

Document Has Been Signed on 12/09/2021 12:46 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:	ELM STREET HEAD START		FACILITY NUMBER:	192005044
ADMINISTRATOR:	MARSHA BULLOCK		FACILITY TYPE:	850
ADDRESS:	1425 & 1429 ELM AVENUE		TELEPHONE:	(562) 218-6220
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY: 85	TOTAL ENROLLED CHILDREN: 36	CENSUS: 30	DATE:	12/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Marsha Bullock & Jenny Acosta		TIME COMPLETED:	01:10 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) Rita Ramos conducted an unannounced required 1 year inspection to the above facility on 12/09/2021. LPA arrived at the facility at 9:10AM, identified self and met with Marsha Bullock, Head Teacher, who guided analyst on a tour of the facility. LPA provided Head Teacher with a copy of the LIC 125 Entrance Checklist to help facilitate the inspection. This is a preschool program which consists of 4 physical classrooms; Room 1, 2, 3, and 4. Facility operation hours are Monday through Friday from 7:45AM to 2:45PM. Room 1 is divided into 2: Room 1A and 1B. Room 1B operates one part-day session from 7:45AM to 11:15AM. LPA was later met by Program Administrator, Jenny Acosta, and Early Learning Center Manager Judith Long. All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Room 1A: Staff #1, #2 with 14 preschoolers; Room 1B: Staff #3, and #4 with 9 preschoolers; Room 2: Staff #5 and #6 with 2 preschoolers; Room 3: Staff #7 with 3 preschoolers; Room 4: Staff #8 with 2 preschoolers. The facility was observed to be within the license capacity and limitations. 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. Linens are washed weekly by a laundry service. Napping equipment (cots) were observed to be stored in the classrooms except in Room 1B. Room 1B children do not nap due to part-day enrollment. Per Program Administrator, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed in classrooms via water pitchers and disposable cups. When inspecting Room 3 at approximately 9:42AM, LPA observed that the 3 preschool children under 36 months of age were working with a material that was not age appropriate. -----Page 1 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

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: ELM STREET HEAD START	FACILITY NUMBER: 192005044
	VISIT DATE: 12/09/2021

NARRATIVE

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The material was shredded particles of white and iridescent plastic in which children were having a difficult time to manipulate by attempting to glue the particles as an art activity. LPA informed the Head Teacher that the particles are too small for the children and can be a chocking hazard especially since they are getting stuck on the fingertips via the glue. LPA observed the package that the material was stored in and read the following: "WARNING! CHOCKING HAZARD-Small parts. Not for children under 3 years". A picture was taken. LPA also observed pieces of aluminum foil in the art area and LPA advised that the foil also be removed because it is easy to tear and can be a choking hazard as well. LPA informed the Head Teacher that the paints and thick crayons are more age appropriate for the activity that was being carried out. Program Director states that there are no poisons on the premises. Carbon monoxide detectors were observed and tested to ensure that they are operable.

This facility has all meals and snack delivered. Food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Trash cans used to discard food have tight fitting lids.

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. There is adequate shade in the play yard. Availability of outdoor drinking water was observed via a water pitcher and disposable cups. 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. There are no firearms stored on the premises. There are no pools or bodies of water at the facility.

All staff and employees have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Long Beach Unified School District. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions. ---Page 2 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

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: ELM STREET HEAD START	FACILITY NUMBER: 192005044
	VISIT DATE: 12/09/2021

NARRATIVE

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LPA did not review medical or confidential information during this inspection due to the forms being stored at the district human resource office.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 12/07/21. Menus were observed to be posted. Preschoolers are provided with a breakfast, lunch, and snack. Children in Room 1B are provided with a breakfast due to part-day enrollment.

First Aid supplies were observed in each classroom. According to the Head Teacher, medication is only administered to a child when accompanied with a doctor's note and is stored in the classrooms in locked boxes.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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/tion-process.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Program Administrator, Jenny Acosta. ---Page 3 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 12/09/2021 12:46 PM - It Cannot Be Edited

Created By: Rita Ramos On 12/09/2021 at 12:19 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: ELM STREET HEAD START	FACILITY NUMBER: 192005044
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(m)

101239(m) Fixtures, Furniture, Equipment and Supplies All play equipment and materials used by children shall be age-appropriate.This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above due to LPA observing that the children under 3 years of age in Room 3 were using a material that is not age appropriate and can be a choking hazard which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/17/2021
	Plan of Correction
1 2 3 4	Per Program Administrator, all classrooms will be inventoried to review all materials and labels to ensure that the materials and equipment are age appropriate. A meeting will be held with staff at the facility and a copy of the meeting agenda will be submitted.

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:

Rita Ramos

LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

LIC809 (FAS) - (06/04)

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