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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402924
Report Date: 07/24/2024
Date Signed: 07/24/2024 01:43:48 PM

Document Has Been Signed on 07/24/2024 01:43 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:SAN FERNANDO VALLEY ACADEMY C. D. C.FACILITY NUMBER:
197402924
ADMINISTRATOR/
DIRECTOR:		WESLEY, ALMAFACILITY TYPE:
850
ADDRESS:17601 LASSEN STREETTELEPHONE:
(818) 206-2117
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 40TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
07/24/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Alma Wesley, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 07/24/2024 at 9:10 AM an unannounced Required – 3 Year Inspection was conducted by Licensing Program Analyst (LPA) Katrina Chicote. LPA announced purpose of visit and initially met with Office Staff who directed LPA to Preschool program. Facility shares location with elementary school and is located to the rear of property. LPA announced purpose of inspection again and met with Facility Representative (FR) Alma Wesley, Director/Teacher, who allowed entry to facility. Facility is currently licensed for a capacity of 40 and per FR, have four enrolled. The program currently operates Monday thru Friday from 7:30 AM to 5:00 PM. LPA was taken on a guided tour of the facility of both indoors and outdoors. Required postings were discussed and LIC 125 was provided.

The facility is made up of two classrooms: Preschool 4-5 and Preschool 2-3. Per FR, only room being used currently is Preschool 4-5 and Preschool 2-3 is currently being used as storage. At the initial start of the site visit, LPA observed three children and a total census of one teacher present, additional child arrived later, total census was four children and one teacher present during inspection.

Beginning at 9:20 AM, furniture and equipment were inspected for age appropriateness and good repair. LPA observed surface of classrooms to be safe and clean, and child size tables and chairs available for children with rounded edges and well maintained. LPA observed Preschool 4-5 room to have a shelves through out the room with a variety of age appropriate toys such as: wooden unit blocks, soft plush toys, art materials, and books. LPA observed the room to have an abundance of clutter through out with items and toys stacked and leaning unbalanced at time of inspection. Telephone service, heating, lighting and ventilation were evaluated. There were cubbies observed as storage for children's belongings. Mats were inspected and observations discussed with FR, LPA observed mats stored in Preschool 2-3. LPA discussed procedures for obtaining nap equipment with FR. Per FR, families bring in the blankets and sheets, though they do have limited amount of children who currently nap at the facility. LPA observed thick sleeping bag like blankets stored in children's cubbies at time of inspection. LPA observed personal water bottles available for children as well children's personal water bottles. Age appropriate sinks and toilets were inspected for
Report Continues - Page 1 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924
VISIT DATE: 07/24/2024
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availability, good repair, water temperature, toilet paper, area safety and sanitation. LPA observed two bathrooms available in Preschool 4-5 that had each had one toilet and LPA observed two sinks available in classroom, totaling two toilets and two sinks for program at time of inspection. LPA observed cleaning solutions stored up high in cabinet with no operable child safety lock at time of inspection. LPA discussed the storage of hazardous items including poisonous cleaning compounds and ensuring that it is inaccessible to varying children's ages and abilities.

A first aid kit is kept on high shelf and LPA inventoried for necessary supplies. At 9:25 AM, LPA observed carbon monoxide detector to not have any batteries at time of inspection. FR states batteries were removed yesterday as it kept beeping and Maintenance was informed yesterday. At 10:40 AM, batteries were placed in carbon monoxide detector and LPA tested carbon monoxide detector and observed operable at time of inspection. LPA observed smoke detectors and fire extinguishers are present in the facility. LPA discussed requirement to have fire extinguishers serviced annually and to conduct regular checks of smoke and carbon monoxide detectors to ensure they are in operable condition. Disaster drill log was available and last drill conducted on 05/15/2024. FR states Isolation area for sick children is in classroom by Teacher Desk. LPA observed a variety of books, paperwork, and other miscellaneous items cluttering area by Teacher Desk. FR states that children do not typically access this area but LPA did not observe any barrier making this area off limits at time of inspection. Per FR, they currently have no children requiring medicines. At 9:35 AM, LPA observed over the counter cough medicines with no label stored in high cabinet with no lock at time of inspection. FR states that cough medicines was for C1 but she no longer requires the medicine at this time, LPA record review did not observe any permissions for C1 to have cough medicines at the facility at time of inspection. Additionally, FR's prescription medicines stored in an open cabinet in Teacher Desk that was fully visible at time of inspection.

Teacher-child ratios were observed and staff name recorded. Care and supervision was evaluated and discussed to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. LPA observed 3 of 4 children signed in at time of inspection.

FR states, facility provides milk and some snacks and lunches are brought from home. LPA observed children's lunch boxes on counter with no label of children's names at time of inspection. LPA did not observe snack menus at time of inspection. Trash cans used to discard food have tight fitting lids at time of inspection.
Report Continues - Page 2 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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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: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924
VISIT DATE: 07/24/2024
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Beginning at 9:45 AM, outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. LPA observed surface of outdoor play areas to be safe and maintained for activities planned. LPA observed plastic swing and climbing equipment on top of sand box area. LPA observed two sandbox areas that were covered by tarp at time of inspection. LPA observed a plastic wading pool that was filled with water and covered by plastic at time of inspection. FR states this was filled in preparation to being used by children, LPA notified FR of requirement that water must be disposed of when not in use by children, LPA observed FR remove water at time of inspection. LPA observed a variety of age appropriate toys available such as tricycles and dramatic play equipment made of plastic and wood. LPA observed a loose screw exposing pointed part and spider webs through out outdoor play area including on play equipment at time of inspection. Required shade and fencing were inspected. LPA observed hay bales used for seating under shaded tree at time of inspection. LPA advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to their water bottles during outside play. Play area was inspected for hazards and inaccessibility to bodies of water.

Beginning at 11:10 AM, staff and children’s records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857 for children and the LIC 859 for staff. FR completed required AB1207 Mandated Reporter training on 10/12/2022. FR did not have proof of current Pediatric First Aid/CPR at time of inspection, record review shows that FR Pediatric First Aid/CPR expired on 10/21/2021. FR did not have proof of Education verification (transcripts or permits), and proof of immunization for TdaP, MMR, and Influenza (or written declination for this only) at time of inspection. FR has obtained a criminal record clearance or criminal record exemption and associated to the facility at time of inspection.

The following were discussed:
LPA advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation, this includes any changes as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Facility Representative was reminded that all adults 18 and over in the facility, 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 facility. 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.
Report Continues - Page 3 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924
VISIT DATE: 07/24/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

Incidental Medical Services (IMS) - Child Care Centers
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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on this information the following deficiencies on the LIC 809 D are being cited today, 07/24/2024.

LPA Chicote informed Facility Representative, Alma Wesley, that this report dated 07/24/2024 document(s) twoType A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Report Continues - Page 4 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 4 of 20
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: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924
VISIT DATE: 07/24/2024
NARRATIVE
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Also, LPA Chicote informed the Facility Representative to provide a copy of this licensing report dated 07/24/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Facility Representative, Alma Wesley.

Report Ends - Page 5 of 5
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 5 of 20
Document Has Been Signed on 07/24/2024 01:43 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/24/2024 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101226(e)(1)(A)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (A) Medications shall be kept in a safe place inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, record review, and interview, Licensee did not meet above requirement. LPA observed two cough medicines in high cabinet with no lock and FR's perscription medication in an open drawer in Teacher Desk that was fully visible and accessible to children at time of inspection. This poses an immediate health, safety, and personal rights risk to children in care.
POC Due Date: 07/25/2024
Plan of Correction
1
2
3
4
LPA observed FR remove children and medicine and place her medicine in purse at time of inspection. LPA discussed that the purse must then be stored somewhere that will be off limits to children in care. Clearing deficiency at time of inspection.
Type A
Section Cited
CCR
101238.5(a)(1)
Wading Pools
(a) Notwithstanding the requirements of Section 101238(e), fencing is not required for inflatable or other portable plastic wading pools with sides low enough for children using the pool(s) to step out unassisted. (1)These pools shall be emptied after each use.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation and interview, Licensee did not meet above regulation. LPA observed a plastic wading pool right in front Preschool 4-5 entrance that was filled with water at time of inspection and covered with plastic. FR states that this was used in preparation for water play and for water to warm. This poses an immediate health, safety, and personal rights risk to children in care.
POC Due Date: 07/25/2024
Plan of Correction
1
2
3
4
LPA observed FR remove water from wading pool at time of inspection. Clearing hazard and deficiency at time of inspection.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
Page: 6 of 20
Document Has Been Signed on 07/24/2024 01:43 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/24/2024 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation and interview, Licensee did not comply with the above redgulation. LPA observed carbon monoxide detector in Preschool 4-5 that had no batteries at time of inspection, FR states battery was removed as it was beeping and requested maintenance to come yesterday to fix it. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/24/2024
Plan of Correction
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2
3
4
LPA observed batteries be placed in Carbon Monoxide detector and was able to be tested at time of inspection. Clearing deficiency during inspection.
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, Licensee did not meet the above regulation. LPA observed Preschool 4-5, that is being used by children, to have clutter through out the room with items stacked and leaning unbalanced at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/23/2024
Plan of Correction
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2
3
4
FR states they will clear everything within two weeks, changing everything, including lay out of room. FR will provide photo LPA by POC date via email.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
Page: 7 of 20
Document Has Been Signed on 07/24/2024 01:43 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/24/2024 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, Licensee did not meet the above regulation. LPA observed a variety of hazards in outdoor play area including a loose screw, dried out plants, and spider webs through out play yard and on outdoor play equipment at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/23/2024
Plan of Correction
1
2
3
4
FR states they will clear hazards observed and provide photo LPA by POC date via email.
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 record review and interview, Licensee did not meet above regulation from 1 of 1 staff files reviewed at time of inspection. FR states she does not have it in the file at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/23/2024
Plan of Correction
1
2
3
4
FR states she will obtain immunization records and provide photo proof to LPA by POC date via email. LPA observed FR call doctor's office over the phone to try to obtain records during inspection.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
Page: 8 of 20
Document Has Been Signed on 07/24/2024 01:43 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/24/2024 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, Licensee did not meet above regulation by 2 of 4 children not having a physician's report. LPA observed a Health Examination Waiver in children's file that is not applicable to this program. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/23/2024
Plan of Correction
1
2
3
4
FR states that C3 will be leaving for Kindergarten and will no longer be enrolled and they will obtain C4's record and provide photo proof to LPA by POC date via email.
Type B
Section Cited
CCR
101226(e)(2)
Health-Related Services
(2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation and interview, Licensee did not meet above regulation. LPA observed two cough syrups stored in high cabinet in Preschool 2-3 that did not have a child safety and not be labeled or dated at time of inspection. FR states this medicine was for C1 that she no longer takes. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/24/2024
Plan of Correction
1
2
3
4
FR states that the child no longer needs the medication and states that it will be taken home by child's Authorized Representative. LPA observed FR remove medicines at time of inspection.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
Page: 9 of 20
Document Has Been Signed on 07/24/2024 01:43 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/24/2024 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(4)(B)
Health-Related Services
(4) Nonprescription medications may be administered without approval or instructions from the child's physician if all of the following conditions are met: (B) For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, Licensee did not meet above requirement. FR states this medication was for C1, LPA record review did not observe anything written approval for medicine in C1's file or attached to medicine at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 07/24/2024
Plan of Correction
1
2
3
4
LPA observed FR remove medicaiton and FR states moving forward she will obtain this requied document. Since medication was removed the deficiency has been cleared on today's inspection.
Type B
Section Cited
CCR
101227(a)(1)
Food Service
(1) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation and interview, Licensee did not meet above regulation. LPA did not observe any snacks available for children, FR states that children bring lunches and snacks from home and that they only provide milk and limited snacks. LPA observed children eating their lunch and requesting additional food to which there was only a limited amount. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/23/2024
Plan of Correction
1
2
3
4
FR states they will provide snacks and provide proof of snack services via a menu that they will put together and provide to LPA by POC date via email. Photos will also be taken of food prep areas to show quanity of quality of foods.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/24/2024 01:43 PM - It Cannot Be Edited


Created By: Katrina Chicote On 07/24/2024 at 12:47 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN FERNANDO VALLEY ACADEMY C. D. C.
FACILITY NUMBER: 197402924

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(f)

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, Licensee did not meet above regulation by 1 of 1 staff not having proof of current Pediatric First Aid/CPR with FR having one that expired on 10/07/2021. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/23/2024
Plan of Correction
1
2
3
4
FR states they have current Pediatric First Aid/CPR training but just did not have proof at time of inspection. FR states they will obtain copy and provide photo proof to LPA by POC date via email.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024


LIC809 (FAS) - (06/04)
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