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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414574
Report Date: 06/30/2022
Date Signed: 06/30/2022 12:01:30 PM

Document Has Been Signed on 06/30/2022 12:01 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KIDSVILLE U.S.A.FACILITY NUMBER:
197414574
ADMINISTRATOR:PERERA, MAUREENFACILITY TYPE:
840
ADDRESS:8472 CORBIN AVENUETELEPHONE:
(818) 886-3508
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 57TOTAL ENROLLED CHILDREN: 57CENSUS: 0DATE:
06/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maureen Perrera- DirectorTIME COMPLETED:
12:15 PM
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On 06/30/2022 Licensing Program Analyst (LPA) Suzette Ornelas, conducted an unannounced Annual Required Inspection for the school age license. LPA met with Director, Maureen Perrera, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 2:30p to 6p.

Center has licensed Preschool (197414572) and licensed Infant Center (197414573) on the premises. LPA toured and inspected the facility in accordance with the facility sketch, programs are kept physically separate by the use of iron gates at least 5 feet tall. School aged license occupies rooms 9, 10, and 11 only. They will use the playground adjacent to the parking lot. Per licensee, the days that the public schools are open, the school age program will operate only from 2:30p to 6p. On the days that public schools are closed, the school age program will not operate, but rather, the children will be part of the private school.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children are toxic free. All toilets and handwashing facilities are in safe and sanitary operating condition. Classroom 11, has two restrooms, each rest-room has a toilet, and a sink. Classroom 9 and Classroom 10 share the restrooms that are located in Classroom 9. There is a toilet and a sink in each restroom. LPA observed solid waste storage containers in the all classroom restrooms are in good repair but were missing the lids. Per licensee, lids will be placed on all waste containers. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food or beverages capable of supporting rapid and progressive growth of microorganisms are stored in covered containers at 45 degrees F or less. Drinking water is available both indoors and outdoors. Playground equipment is in 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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIDSVILLE U.S.A.
FACILITY NUMBER: 197414574
VISIT DATE: 06/30/2022
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 Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents.

Facility has one or more functioning carbon monoxide detectors that meet statutory requirements located in classrooms 9, 10, and 11. Fire extinguisher located in the school aged facility was serviced in December 2021. The Department has inspection authority as specified in Health & Safety Code. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply with the department’s exclusion order. Per director, capacity and limitations as specified on the license are being maintained. LPA observed at least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at off site activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 14 children in care. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. LPA reviewed a sample of staff files and observed files with educational background, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. LPA observed that at least 1 staff member was missing either MMR/Tdap immunization record in the file. Menus are posted at least one week in advance where an authorized representative can view them in all three classrooms.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: KIDSVILLE U.S.A.
FACILITY NUMBER: 197414574
VISIT DATE: 06/30/2022
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LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC809 (FAS) - (06/04)
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