197493808-6-5-2024-30-CC-LPHS-D5XTNW-20240605145325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493808
Report Date: 06/05/2024
Date Signed: 06/05/2024 02:53:37 PM

Document Has Been Signed on 06/05/2024 02:53 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	HAWTHORNE SCHOOL DISTRICT PRESCHOOL		FACILITY NUMBER:	197493808
ADMINISTRATOR/ DIRECTOR:	HELEN BELLOSO		FACILITY TYPE:	850
ADDRESS:	13928 KORNBLUM AVE		TELEPHONE:	(310) 676-1934
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY: 160	TOTAL ENROLLED CHILDREN: 160	CENSUS: 29	DATE:	06/05/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:45 AM
MET WITH:	Helen Belloso, Director		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

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On 3/6/2024 Licensing Program Analysts Loyce Phillips and Devon Carus conducted an unannounced Required Year Inspection for the preschool license. Licensing Program Analysts met with Director, Helen Belloso and toured the facility indoors and outdoors. Licensing Program Analysts observed 4 preschool classrooms. The facility has 2 sessions. During the morning session LPAs observed 29 children with 4 teachers, and observed 26 children with 4 teachers for the afternoon session. Days and hours of operation are Monday through Friday 8:30am to 11:30am (morning session) 12:15pm to 3:15pm (afternoon session).

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 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. 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. All toilets and hand washing faucets are in safe and sanitary operating condition. Floors in the facility are clean and safe. The facility provides breakfast, and lunch. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors Areas around high climbing equipment have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has a functioning carbon monoxide and smoke detectors that meet statutory requirements.

809-C

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HAWTHORNE SCHOOL DISTRICT PRESCHOOL	FACILITY NUMBER: 197493808
	VISIT DATE: 06/05/2024

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Prior to working or volunteering in a licensed child care facility, all individuals are subject to a criminal record review and have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. 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 12 children in care. Licensing Program Analysts 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 and medical assessment. Licensing Program Analysts reviewed a sample of staff files and observed files were complete with health screening, and current documentation of completed Mandated Reporter Training. Menus are posted one month in advance where an authorized representative can view them.

Incidental Medical Services (IMS) are not being provided. Director 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.

Licensing Program Analysts and Director 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, 1 deficiency is cited.

An exit interview was conducted, a copy of this report was read and provided to the Director. Appeals rights were discussed and LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/05/2024 02:53 PM - It Cannot Be Edited

Created By: Loyce Phillips On 06/05/2024 at 02:37 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: HAWTHORNE SCHOOL DISTRICT PRESCHOOL	FACILITY NUMBER: 197493808
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

(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 the licensee did not comply with the section cited above in 4 out of 4 employees were missing a comibination of MnMR,TDAP and FLU immunizations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/17/2024
	Plan of Correction
1 2 3 4	Director will obtain immunizations from staff and send a copy 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:

Karren Starks

LICENSING EVALUATOR NAME:

Loyce Phillips

LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

LIC809 (FAS) - (06/04)

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