195700031-2-2-2023-58-CC-DLOE-CNP39M-20230202170321

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700031
Report Date: 02/02/2023
Date Signed: 02/02/2023 05:03:53 PM

Document Has Been Signed on 02/02/2023 05:03 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:	BOULEVARD SCHOOL, THE		FACILITY NUMBER:	195700031
ADMINISTRATOR:	CARRIE ZUCKERMAN		FACILITY TYPE:	850
ADDRESS:	23022 VICTORY BLVD		TELEPHONE:	(818) 863-0607
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY: 203	TOTAL ENROLLED CHILDREN: 202	CENSUS: 159	DATE:	02/02/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:09 AM
MET WITH:	Applicant Jeff Zuckerman		TIME COMPLETED:	05:00 PM

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On 02/02/2023 at 8:09 a.m. Licensing Program Analysts (LPAs) Deborah Lowe and Suzette Ornelas met with Applicant Jeff Zuckerman, Director Jennifer Will, and Assistant Director Rodi Vogal. The purpose of the visit was an announce pre-licensing inspection at the facility to ensure that health, safety and personal rights as requires by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. There were 159 children present during this inspection. This is a change of ownership application for 203 children, ages 18 months to entry into 1^st grade. The child care center will operate Monday – Friday 7:30 a.m. – 5:30 p.m. The fire clearance was approved on 01/13/2023.

LPAs Lowe and Ornelas toured and measured the on-limits areas and classrooms located at the facility. Carrie Zuckerman, Applicant arrived during the tour and measuring of the outdoor area. The facility has a total of 17 classrooms. Children will have access to 19 sinks and 23 toilets.

Classroom measurements are:

Toddler Option will be conducted in Room 1 & Room 2. Indoor total measurements are 846.26 square (sq) feet (ft) divided by 35 sq ft = 24 children.

Preschool age children will use Rooms, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 16, 17, and 18. (There is no room 13). Indoor total measurement are 6339.18 sq ft divided by 35 sq ft = 181 children.

Outdoor Play measurements are:

Toddler Option yard located in front of Rooms 4, 5, and 6. Toddler Option total outdoor measurements 3129.02 sq ft divided by 75 sq ft = 41 children.

Facility has 3 preschool outdoor play yards. The 2 year old yard is located near rooms 7, 8, 9 , 10, & 11. The 3 year old yard is located behind rooms 4, 5, and 6. The 4-5 year old yard is located in the font of the facility across from the office.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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Total outdoor measurements 18, 688.6 sq ft divided by 75 sq ft = 249 children.

Application is requesting 24 toddlers ages 18 months to 30 months and 179 Preschool ages 2 years to entry into 1^st grade.

Indoor/Children’s Area:

All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard were observed to be free of obstruction. The child care center was observed be clean, safe, sanitary and in good repair.. Floors of all rooms have a surface that was observed to be safe and clean. A comfortable temperature for children was observed. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to be meet the needs of the children. All indoor play equipment and materials used by children were observed to be age-appropriate. Classrooms were observed with individual cubby space for clothing, personal belongings and/or bedding. All materials and surfaces accessible to children, including toys, were observed to be free of toxic substances.

Drinking water from a noncontaminating fixture or container was observed to be readily available both indoors and in the outdoor activity area. Children bring water bottles from home and facility provides water refills with use of Brita water filter pitcher. Facility uses a pest control service to keep the center free of flies, other insects, and rodents. All containers used for storage of solid waste were observed with tight fitting lids. Facility was observed with no fireplaces or open face heaters.

Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were observed to be stored where inaccessible to children. LPAs observed a current edition of a first-aid manual, sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution.

LPAs advised the isolation area shall be located to afford easy supervision of children by center staff. Per Director, The isolation is located in the conference room located in the office area. LPAs observed conference room to be equipped with a mat for each ill child. LPAs advised the isolation area shall not be located in the kitchen area or the general-use toilet area.

Facility was observed with more than one carbon monoxide detectors. LPAs were able to hear a successful test. Facility was observed with a working telephone service on the premises.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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LPAs observed sign in/ out sheets with space available for parent/ guardian full signature.

LPAs advised the licensee shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.

LPAs advised smoking is prohibited on the premises of a child care center as specified in Health and Safety Code Section 1596.795(b). A baby walker shall not be allowed on the premises of a child care center in accordance with Health and Safety Code Sections 1596.846(b) and (c).

There shall be at least 35 square feet of indoor activity space per child based on the total licensed capacity. Based on the total licensed capacity, one toilet and one handwashing fixture shall be maintained for every 15 children, or fraction thereof. Toddler option children will have access to 3 toilets and 3 sinks. Preschool children will have access to 23 toilets and 16 sinks.

Napping:

LPAs observed mats used for napping to be maintained in a safe condition. LPAs observe mats to be constructed of foam at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Marked or colored so that the sleeping side can be distinguished from the floor side. Wiped with a detergent/disinfectant weekly or when soiled or wet.

LPAs observed the mats to be maintained in a safe condition with no exposed foam. Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.

LPAs observed a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.

Restrooms:

All toilets, handwashing and bathing facilities were observed be maintained in safe and sanitary operating condition. LPA advised additional equipment, aids and/or conveniences shall be provided as needed in centers that serve children with physical disabilities.

LPAs advised hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature of not less than 105

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). LPAs check and verified faucet temperature of 115 degrees.

LPAs advised notwithstanding (e) and (e)(1) above, handwashing fixtures shall not be required to deliver hot water.

Facility will use the staff bathroom located in the office area for use of a child in the isolation area. This toilet and handwashing fixture was observed to be conveniently located in relation to the isolation area.

Outdoor:

LPAs observed a shaded rest area for the children. Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. As a condition of licensure, the areas around and under high climbing equipment, swings, slides were observed to be cushioned with sand.

Outdoor climbing structures located on toddler yard, 3-year-old yard, and the 4-5 year old yard are in need of verifying appropriate age range for use. Toddler yard play structure age range sticker was listed as ages 2 years to 5 years, 3-year-old yard play structure was missing an age range sticker, and the 4-5 year old yard age range sticker was listed as ages 5 years to 12 years old.

Wooden trolly located on the 4-5 year old yard was observed to be in need of repair.

LPAs advised sandboxes shall be inspected daily and kept free of hazardous foreign materials.

The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence was observed to be at least four feet high.

LPAs advised any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. This shall include, but not be limited to, incinerators, air- conditioning equipment, water heaters, and fuse boxes.

LPAs observed in-ground pool located across from Toddler Yard near office building. LPAs observed the pool area to be enclosed by a black metal gate measuring 5 feet 9 inches in height. Two entrance gates were observed to swing away from the pool and closes and self-latches. Latch is located at the top of the gate. One walk through gate is located near the office building and the other walk-through gate is located near the

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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toddler yard. Gate located near the toddler yard was observed to self-latch; however, had a slow close. LPAs advise best practice for child safety is to have spring in gate looked at due to is has a slow close. Per Director, the facility only uses walk-though gate located near the office.

Per Director, pool is used during summer months only for swim lessons. Director stated, a WSI certified swim instructor provides the swim lessons with a member of facilities teaching staff providing overall supervision.

There shall be at least 75 square feet per child of outdoor activity space based on the total licensed capacity.

Health Related Services:

Medications were observed to be kept in a in a locked cabinet in the office inaccessible to children. A refrigerator located in the conference room was observed to be used to store any medication that requires refrigeration.

Facility uses LIC 9221 Parent Consent for Administration of Medication and Medication Chart.

Food Service:

LPAs advised All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.

LPAs advised all foods or beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F (7.2 degrees C) or less.

LPAs advised pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored.

LPAs observed soaps, detergents, cleaning compounds or similar substances to be stored in areas separate from food supplies.

LPAs observed a kitchenette located in room 8 with a refrigerator and countertop. LPAs observed a kitchenette located in the conference room with a sink, stove / oven, and a refrigerator. Facility does not have a full service kitchen.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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LPAs advised the food-preparation area shall not be used for: Children's play activities, unless such activities are part of a supervised food-education program.

Per Director, facility provides two snacks a day and children will bring lunch from home.

Postings:

LPAs advised the facility license shall be posted in a prominent, publicly accessible location in the front of the facility.

LPAs observed the following postings: LIC 613A (9/96), PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster, LIC 610 with the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5, and LIC 9148 Contingency plans for action during fires, floods and earthquakes.

LPAs observed snack menu posted in the office and in each classroom. LPAs advised copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

LPA advised the licensee shall reveal each child care center license number in all advertisements in accordance with Health and Safety Code Section 1596.861.

The following items were discussed:

Applicant and Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant and facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant and facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 6 of 10

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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)/ (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 reviewed with applicant and facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed before a licensure will be considered. Corrections are due by 02/17/2023:

· Verify age-appropriate use of outdoor climbing structures on Toddler yard, 3-year-old yard, and 4–5-year-old yard.

· Trolly located on 4-5-year-old yard is in need of repair.

· Fire Extinguisher in need of service. Last service date was observed as 01/18/2022.

· Revised Fire Clearance to include room usage. LPA Lowe will contact Fire Inspector.

· Pool gate near toddler yard have spring in gate looked at due to is has a slow close.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 7 of 10

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: BOULEVARD SCHOOL, THE	FACILITY NUMBER: 195700031
	VISIT DATE: 02/02/2023

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 26 27 28 29 30 31 32	An exit interview was conducted with the above items discussed and a copy of appeal rights and this report was provided to the Applicant, Carrie Zuckerman and Director, Jennifer Will. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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