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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700052
Report Date: 04/27/2023
Date Signed: 04/27/2023 09:38:16 AM

Document Has Been Signed on 04/27/2023 09:38 AM - 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 ACADEMYFACILITY NUMBER:
195700052
ADMINISTRATOR:ANA M CARDENAS PEREZFACILITY TYPE:
850
ADDRESS:20440 LASSEN STREETTELEPHONE:
(818) 280-9463
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 40TOTAL ENROLLED CHILDREN: 11CENSUS: 10DATE:
04/27/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:Ana Cardenas PerezTIME COMPLETED:
09:50 AM
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On 04/27/2023 Licensing Program Analysts (LPAs) Deborah Lowe and Maria Rendon met with Applicants Ana Cardenas Perez. The purpose of the visit was a second 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 40 children, ages 2 years to 5 years old. The child care center will operate Monday – Friday 7:00 a.m. – 6:00 p.m. The fire clearance was approved on 1/11/2023.

Facility is located on the property of Congregational Church of Chatsworth. Facility address is currently licensed under a different licensee. The currently licensed program will be closing. LPAs Lowe and Rendon observed 10 children in care supervised by staff S1 and L1.

The first pre-licensing visit was conducted on 04/14/2023. LPAs Lowe and Rendon are conducting a second pre-licensing visit to evaluate the facility corrections needed before a license application will be considered.

On 04/14/2023 the following items needed corrections:

  • Room 1 and Room 2 clean tile floor – observed with possible stains
  • Room 1 repair tile floor – observed with broken tile.
  • Outdoor area, sprinklers system is in need of repair, 4 devices observed with broken and sharp points
  • Wooden planters in the outdoor area observed with peeling paint.
  • Verify age usage of climber
  • Provide Mass Casualty Disaster Plan
  • Applicant to submit outdoor waiver for shared usage with no commingling.
  • Applicant to submit bathroom waiver for shared usage with no commingling.

On 04/20/2023 LPA Lowe was notified by the applicant that the requested corrections have been completed.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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: 195700052
VISIT DATE: 04/27/2023
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On 04/20/2023 applicant notified LPA Lowe the applicant is withdrawing their application for a school license. The needed corrected items above for an outdoor waiver and a bathroom waiver are no longer required due to the withdraw of the school age application.

On 04/27/2023 LPAs Lowe and Rendon observed the following:

LPAs Lowe and Rendon observed the tile floor in room 1 and 2 to have been cleaned. LPAs observed the tile floor is stained but was clean. LPAs observed the broken tile in room 1 has been repaired.

LPAs observed the wooden planters located in the outdoor play area to have been repainted with no visible paint peeling.

LPAs observed the outdoor area to have had all broken devices removed.

LPAs verified the age usage for the climber located in the outdoor area to be for ages 2-years to 5-years-old.

LPAs were able to review the mass casualty disaster plan.

LPAs review reporting requirements with applicant.

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.

Application is pending an updated facility sketch and verification of director qualifications.

Applicant will email LPA Lowe with a new facility sketch labeling the off-limit areas by 05/01/2023.


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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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