195700051-4-14-2023-58-CC-DLOE-CQVUZR-20230414160157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700051
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:02:37 PM

Document Has Been Signed on 04/14/2023 04:02 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:	CHATSWORTH COMMUNITY ACADEMY		FACILITY NUMBER:	195700051
ADMINISTRATOR:	ANA M CADENAS PEREZ		FACILITY TYPE:	840
ADDRESS:	20440 LASSEN STREET		TELEPHONE:	(818) 280-9463
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 3	CENSUS: 0	DATE:	04/14/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:11 AM
MET WITH:	Ana Cardenas Perez		TIME COMPLETED:	11:40 AM

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On 04/14/2023 Licensing Program Analysts (LPA) Deborah Lowe met with Applicants Ana Cardenas Perez and Leo Lynch. 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. This is an application for 25 school age children, ages 5 years to 12 years old. The child care center will operate Monday – Friday 3:00 pm – 6:00 p.m. and 7:00 am – 6:00 pm when school age children are on vacation from school. The fire clearance was approved on 01/11/2023. Applicant has a pending application for a Preschool License #195700052.

No children were present during this inspection. Facility is located on the property of Congregational Church of Chatsworth. LPA Lowe toured and measured the on-limits areas and classroom located at the facility. The facility has a total of 1 school age classroom, Room 4. Children will have access to 5 sinks, 4, toilets, and 2 urinals.

Classroom measurements are:

Indoor total measurements: 903.65 square feet divided by 35 square feet = 25 school age children.

Outdoor Play measurements are:

Outdoor total measurements: 8158.86 square feet divided by 75 square feet = 108 children.

Facility has one outdoor playground, per applicants they will request a waiver for the outdoor area to be used by both preschool and school age with the use of alternate schedules to ensure no commingling.

Indoor/Children’s Area:

All outdoor and indoor passageways, open porches and other areas of potential hazard were observed to be free of obstruction. The child care center was observed be clean and sanitary. Tile Floor in room 4 was observed to need repair, broken tile. A comfortable temperature for children was observed.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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: CHATSWORTH COMMUNITY ACADEMY	FACILITY NUMBER: 195700051
	VISIT DATE: 04/14/2023

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Brown exit door in room 4 was observed in need of repair with peeling paint. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Counter top with sink located in Room 4 was observed to need repair on the side near the wall, was observed broken with sharp edge. Tables and chairs were observed to be meet the needs of the children. All play equipment and materials used by children were observed to be age-appropriate. LPA observed individual storage space for children’s clothing and personal belongings. All materials and surfaces accessible to children, including toys, were observed to be free of toxic substances.

Trash cans were observed with tight fitting lids and were in good repair. No fireplaces or open-faced heaters we observed at facility. All window screens were observed to be in good repair and free of insects, dirt and debris. 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. Storage areas for poisons shall be locked. LPA 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. LPA observed a carbon monoxide detector in Room 4. LPA Lowe was able to hear a successful test of the detector. LPA advised, all child care centers shall have working telephone service on the premises.

Isolation area is located in the director’s office near the entrance to the facility. The isolation area was observed with cot for an ill child. LPA advised, the isolation area shall not be located in the kitchen area or the general-use toilet area.

Sign in / out sheets were observed on a table at the entrance of the facility with space available for the parent/ guardian to provide full signatures. LPA 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.

LPA 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).

Restrooms:

Facility was observed with two restrooms children will have access too. Bathroom facilities were observed to be maintained in safe and sanitary operating condition. LPA advised, additional equipment, aids and/or page 2 of 7

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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: CHATSWORTH COMMUNITY ACADEMY	FACILITY NUMBER: 195700051
	VISIT DATE: 04/14/2023

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conveniences shall be provided as needed in centers that serve children with physical disabilities. LPA advised; toilets used by school-age children shall provide individual privacy. Toilet facilities shall not be used simultaneously by children of both sexes. Handwashing sinks were observed to administer cold water.

Children who are in the isolation area will have access to the adult restroom located in the office next to the Director’s office near the entrance to the facility.

Outdoor:

LPA observed a shaded rest area for the children. Outdoor area was observed with hazards of 4 broken landscaping equipment with broken parts and sharp pointed parts. Wooden planters were observed with peeling paint. The areas around and under high climbing equipment, swings, slides and other similar equipment was observed be cushioned with material that absorbs falls, sand.

LPA advised, sandboxes shall be inspected daily and kept free of hazardous foreign materials. The playground was observed to 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. The route from the classroom to the outdoor playground the children will travel through a parking area that is locked and not used Monday – Friday, located in the back of the facility away from the main street. Monday – Friday parking for the school to use is located at the front of the property near the entrance to the facility.

Facility has a fenced in breezeway outside of the classroom doors, facility will use for supervised activities. Breezeway will not be occupied by preschool and school age at the same time.

In combination programs, outdoor activity space provided for school-age child care center children shall be physically separated from space provided for other child care center children. Facility has one outdoor playground, per applicants they will request a waiver for the outdoor area to be used by both preschool and school ages with the use of alternate schedules to ensure no commingling.

LPA 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. LPA advised, Blue Storage Shed located in the enclosed outdoor playground shall have a lock on the shed door to ensure the shed is inaccessible to the children.

There are no pools or other bodies of water at the facility. page 3 of 7

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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: CHATSWORTH COMMUNITY ACADEMY	FACILITY NUMBER: 195700051
	VISIT DATE: 04/14/2023

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Health Related Services:

LPA advised, Medications shall be kept in a safe place inaccessible to children. A refrigerator shall be used to store any medication that requires refrigeration. A refrigerator was observed in the kitchen.

LPA advised, the licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given. LPA Lowe reviewed LIC9221 Parent Consent for Administration of Medications and Medication Chart with applicants.

Food Service:

Classroom was observed with a water fountain at the sink and use of plastic Rubbermaid water containers with disposable cups. LPA advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure. LPA Lowe provided applicant with a printed copy of PIN-21-21-CCP.

LPA 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.

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.

LPA 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. Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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: CHATSWORTH COMMUNITY ACADEMY	FACILITY NUMBER: 195700051
	VISIT DATE: 04/14/2023

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LPA observed the kitchen, food-preparation and storage areas to be clean and free of litter and rubbish. LPA 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. Full-day programs shall offer a midmorning and a midafternoon snack.

Per applicants, the facility will provide all food for the children, snacks and lunch.

Postings:

LPA advised the license shall be posted in a prominent, publicly accessible location in the center. LPA Lowe observed the following postings: LIC 613A (9/96), the PUB 393 (8/02), Child Care Center Notification of Parents' Rights Poster, LIC 610 Emergency Disaster Plan with the telephone number of the local health department, information on child passenger restraint systems, and a contingency plan for action during fires, floods and earthquakes.

Menu was observed posted showing snack and lunch. LPA 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 each licensee shall have a disaster and mass casualty plan of action. Per applicant, the applicant will send the disaster and mass casualty plan of action to LPA for review.

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.

Transportation:

Per applicant parents will provide transportation. Applicant is looing into providing transportation from elementary school to facility at a later time.

The following items were discussed:

Applicant 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,

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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: CHATSWORTH COMMUNITY ACADEMY	FACILITY NUMBER: 195700051
	VISIT DATE: 04/14/2023

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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.

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 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 04/28/2023:

Tile floor in Room 4 is in need of repair – tile observed broken
Exit door in Room 4 leading to the breezeway - brown paint is peeling from door.
Counter top in Room 4 with sink, side piece is in need of repair – observed broken with sharp edge.
Provide Mass Casualty Disaster Plan
Outdoor area, sprinklers system is in need of repair, observed 4 devices with broken and sharp points

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

Page: 2 of 15

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: CHATSWORTH COMMUNITY ACADEMY	FACILITY NUMBER: 195700051
	VISIT DATE: 04/14/2023

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Wooden planters in the outdoor area observed with peeling paint.
Verify age usage of climber
Applicant to submit outdoor waiver for shared usage with no commingling.
Applicant to submit bathroom waiver for shared usage with no commingling.

An exit interview was conducted with the above items discussed and a copy of appeal rights and this report was provided to the Applicant Ana Cardenas Perez. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues.

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SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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