<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416691
Report Date: 03/18/2025
Date Signed: 03/18/2025 04:35:25 PM

Document Has Been Signed on 03/18/2025 04:35 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:BROAD AVENUE ELEMENTARY SCHOOL CSPPFACILITY NUMBER:
197416691
ADMINISTRATOR/
DIRECTOR:		EVER-ALLEN, DEBORAHFACILITY TYPE:
850
ADDRESS:24815 BROAD AVENUE RM.13TELEPHONE:
(310) 835-3118
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 12DATE:
03/18/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:34 AM
MET WITH:Xochitl Vazquez - PrincipalTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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
Licensing Program Analyst (LPA), Keyona Scott, conducted an unannounced 3 - Year Required Annual inspection to the California State Preschool Program located at Broad Avenue Elementary School on 03/18/2025 at 8:34 AM. LPA met with facility representative (S1) at 8:42 AM. LPA met with Prinicipal, Xochitl Vazquez, at 9:55 AM and was guided on a tour inside and outside of the school area utilized by the preschool. LPA observed proper teacher to children ratios. At approximately 10:00 AM, LPA observed the following: twelve (12) children to one (1) teacher and one (1) aid during circle time in classroom 13. As a condition of employment, all individuals working or present at the facility that is operated by a school district shall obtain a criminal record clearance or criminal record exemption. The school district shall notify the Regional Office, if there is a change of status of an individual's criminal record clearance.

This is a preschool program that utilizes classroom 13 on the elementary school premises. The state preschool program serves children ages two years and 9 months (2.9) old to five (5) years old. The preschool center operation hours are Monday through Friday 8:00 AM to 2:23 PM. Facility serves two (2) meals, breakfast and lunch. Principal advised that additional snack is available upon request from the cafeteria and parent's also occasionally provide child(ren) with additional snack from home. LPA advised Principal to ensure that any children's food containers and water bottles brought from the child's home are labeled with the child's name and properly stored and/or refrigerated. The preschool children are dropped off and picked up at the Kindergarten Gate.

PHYSICAL PLANT
All areas identified on the Facility Sketch were inspected. The preschool program consists of one (1) classroom. LPA observed the following in the classroom: outlet covers over the electrical outlets not in-use, stored napping mats in cabinet, children's lunch bags and personal belongings stored in cabinet, circle time carpet, table and chair sets, kitchen play set, books and other age-appropriate playthings.
PAGE 1
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 11
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: BROAD AVENUE ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416691
VISIT DATE: 03/18/2025
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
The facility was kept clean, neat and orderly. The preschool restroom is located outside of the preschool classroom across from classroom 13 in the Girls elementary restroom. The preschool program utilizes one (1) stall, the first stall of the girls elementary restroom and one (1) sink also located in the Girls elementary restroom. LPA observed the toilet and sink to be safe, sanitary and functional. There is a waiver on file for the exclusive use of restrooms per California Code of Regulations (CCR), Title 22, Division 12, Section 101239, granting the waiver under the following conditions:
  1. Usage of the restrooms is not to occur at the same time as usage by the elementary school.
  2. Teachers and/or aides shall supervise use of the restrooms during preschool usage.
  3. Teachers and aides shall accompany children to ensure the absence of other children in the restroom and monitor continuously while the preschool children are present.

All poisons and hazardous items are stored and inaccessible to children in care. All floors are clean and safe. LPA observed the classroom and all kitchen areas and/or food preparation areas clean and free of litter and other hazardous items.

Outdoor play area is located on the kindergarten playground. Per Principal, the preschool program utilizes the north side of the outdoor play area on the kindergarten play area. The preschool outdoor play area is separated from the other area of the kindergarten play area via cones. Preschool outdoor play equipment is stored when not in use. LPA observed the outdoor play area to be in safe condition and free of sharp, loose or pointed parts. LPA did not observe any bodies of water to include in-ground pools on the facility premises. There is also a waiver on file for the required fencing to separate outdoor activity space for other program children per CCR, Title 22, Division 12, Section 101238.2, granting the waiver under the following conditions:
1. Usage of the play area will not occur at the same time as other program children.
2. Schedule shall be posted and adhered to at all time.
3. No child shall be outside on the playground without direct visual supervision by adult staff.
4. The required 1:24 teacher to child ratio and the 1:8 adult to child ratio shall be maintained at all times.
5: Children may not co-mingle with children from other programs on the playground. They are to be kept with their own group at all times.

Drinking water is readily available both indoors and outdoors.
PAGE 2
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 2 of 11
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: BROAD AVENUE ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416691
VISIT DATE: 03/18/2025
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
FACILITY RECORDS
There is at least one person present at facility that is trained in Pediatric CPR and First Aid. LPA advised Principal that all preschool staff are to complete Mandated Reporter training every two years and certificate of completion is to be placed in each staff's individual file at the school site and made readily available for review upon Department's request.

LPA advised Principal that the following Personnel Records are to be maintained at the school site and made readily available for review upon the Department's request:
  • Staff Qualifications
  • Current Pediatric CPR and First Aid Certification
  • LIC 9108 (Statement Acknowledging Requirement to Report Child Abuse)
  • Mandated Reporter Training Certificate
  • LIC 9052 (Employee Rights)


LPA reviewed for the following Children's Record of four (4) children's files during today's inspection:
  • LIC 613A (Personal Rights)
  • Admission agreement
  • LIC 700 (Identification and Emergency Information)
  • LIC 701 (Physician's Report)
  • LIC 995 (Notification of Parents' Rights)
  • LIC 627 (Consent for Emergency Medical Treatment)
  • Immunization Record

LPA observed the following posted documents in classroom 13 during today's inspection:
  • Facility License
  • PUB 269 - Child Passenger Restraint System Poster
  • PUB 393 - Notification of Parents' Rights (posted with incorrect Regional Office address)
  • LIC 613A- Personal Rights (posted with incorrect Regional Office address)



PAGE 3
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 3 of 11
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: BROAD AVENUE ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416691
VISIT DATE: 03/18/2025
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
FACILITY RECORDS (continued)
LPA advised Principal that required documents to be posted are to be posted in a prominent, publicly accessible area at the facility. Per Principal, parents do not have access to the preschool classroom. Principal advised LPA, the following required documents will be posted in the administration office at the elementary school:
  • Facility License
  • Menus
  • PUB 269 - Child Passenger Restraint System Poster
  • PUB 393 - Notification of Parents' Rights
  • LIC 610 - Emergency Disaster Plan
  • LIC 613A - Personal Rights

Principal provided LPA with a copy of the following document during today's inspection:
  • Broad Avenue School Emergency Organization Plan 2024-2025; LPA advised Principal to post as required document with LIC 610.


LPA provided Principal with the following required documents during today's inspection:
  • PUB 393 - Notification of Parents' Rights (with current Regional Office address)
  • LIC 610 - Emergency Disaster Plan
  • LIC 613A - Personal Rights (with current Regional Office address)


LPA advised Principal to print and post the following required posting document during today's inspection:
  • PUB 269 - Child Passenger Restraint System Poster

LPA reviewed the following documents during today's inspection:
  • Verification of Disaster and Fire Drills: Per review, last fire and disaster drills were conducted on 01/30/2025, 02/24/2025 and 02/26/2025.
  • Daily Activity Schedule
  • Sign In/Out Sheets
PAGE 4
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 4 of 11
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: BROAD AVENUE ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416691
VISIT DATE: 03/18/2025
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
LPA provided Principal with the following document to maintain on file and made readily available for review upon the Department's request:
  • LIC 9148 - Earthquake Preparedness Checklist

LPA identified the following locations during today's inspection:
  • Medication Storage Area for Children Requiring Permissible Medical Services- Per Principal, there are no children currently enrolled that require permissible medical services.
  • Functioning Carbon Monoxide Detector, Smoke Alarm(s) and Fire Extinguisher(s)

The facility was operating in substantial compliance during today’s inspection on 03/18/2025. Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies cited.

The following was thoroughly discussed:
Principal was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA referred Principal to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) 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/.

Principal 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.
PAGE 5
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 5 of 11
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: BROAD AVENUE ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416691
VISIT DATE: 03/18/2025
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
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.

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

Exit interview conducted and report was reviewed with the Principal, Xochitl Vazquez.
PAGE 6
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Keyona Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
Page: 6 of 11