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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494730
Report Date: 12/17/2021
Date Signed: 12/17/2021 02:53:24 PM

Document Has Been Signed on 12/17/2021 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHEPHERD'S FOLD PRESCHOOL - GARDENAFACILITY NUMBER:
197494730
ADMINISTRATOR:INGERSOLL, TROY PAULFACILITY TYPE:
850
ADDRESS:1409 W. 182ND STREETTELEPHONE:
(310) 324-9736
CITY:GARDENASTATE: CAZIP CODE:
90248
CAPACITY: 72TOTAL ENROLLED CHILDREN: 29CENSUS: 19DATE:
12/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Laura Perez-Chasco : DirectorTIME COMPLETED:
03:15 PM
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On 12/17/2021 Licensing Program Analyst (LPA) Chandler made an unannounced visit to Shephard's Fold Pre-School in Gardena for the purpose of conducting a 1 year required/ Annual Random Inspection. LPA met with director Laura Perez-Chasco who provided a tour of the facility. The pre-school operates Monday - Friday, 6:00 A.M to 6:00 P.M

The following was observed of the:

Care and Supervision was observed, Upon arrival LPA inspected 4 classrooms; in the Starlight room, LPA observed 10 children under the supervision of 3 staff members, in the Rainbow room there were 9 children under the supervision of 1 staff member. Ratios and capacity were within the scope of the license.

Each class was equipped with fire extinguishers of 2AB10C or larger series. Carbon monoxide detectors and smoke detectors were observed in each classroom. Age appropriate toys and equipment were observed in good repair. The rooms temperature was set at a comfortable temperature for children in care.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2021
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHEPHERD'S FOLD PRESCHOOL - GARDENA
FACILITY NUMBER: 197494730
VISIT DATE: 12/17/2021
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 Adequate lighting was observed, storage for children’s belongings were observed, Trash cans were observed with tight fitting lids. Classrooms were clean and sanitized. Restrooms in each class were observed toilets and sink were age appropriate and in operable condition. The classrooms are not equipped with working telephones, the nearest working telephone is located in the office. Children nap in their classrooms with cots and tight fitting sheets, cots were observed in good condition.

The required postings were also posted in pertinent area for review of parents and visitors. The facilities last emergency drill was conduct in October 2020. LPA advised director Perez that drills should be conducted either quarterly or bi- annually.

The directors office is used for isolation of ill children, a cot is available for resting and children uses the staff restroom or if the sunbeam classroom is not being used children will be isolated there. A first aid kit was located in office with the required essentials: scissors, bandages, tweezers, and thermometer

Disinfectants, cleaning solutions and other toxins or poisons were made inaccessible to children in care, LPA did not observe any of these items in the children's classrooms

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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: SHEPHERD'S FOLD PRESCHOOL - GARDENA
FACILITY NUMBER: 197494730
VISIT DATE: 12/17/2021
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Lunches and snacks are provided by the facility, weekly menus were posted for review. The center has a full kitchen preparing meals. Refrigeration was provided for foods capable of supporting rapid contamination or spoil. Open foods were properly labeled and stored. LPA did not observe any contaminated foods in this area. The kitchen was clean and in good condition. Children use their personal water containers and the center provides water using a filtered water dispenser.

Center provides Incidental Medical Services, LPA observed, consent, prescriptions on file and proper storage of medicines. Medicines were stored in the kitchen within close proximity to classrooms.

Age appropriate toys and equipment were observed in the outdoor activity space in good repair. The play yard was completely gated with a 4 inch or higher gate. Resilient cushioning was observed to be in fair repair under all climbing apparatus. No hazardous conditions or equipment was observed during today’s visit. Water is provided through a filtered water dispenser and personal containers. An awning provided shading and benches were observed for resting.

Children files were reviewed and found to complete and current. Some documents were missing in various staff files. A roster was readily available for review. Parents an authorized adults sign in using an electronic sign in and out device, such devise shall be capable of printing a hard copy of signatures upon request of licensing or other enforcement agencies

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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: SHEPHERD'S FOLD PRESCHOOL - GARDENA
FACILITY NUMBER: 197494730
VISIT DATE: 12/17/2021
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee Laura Perez Chasco facility representative was reminded that all adults 18 and over, 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.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

Exit interview conducted and report was reviewed with the facility representative, Laura Perez-Chasco.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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Document Has Been Signed on 12/17/2021 02:53 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 12/17/2021 at 02:24 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: SHEPHERD'S FOLD PRESCHOOL - GARDENA
FACILITY NUMBER: 197494730

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on record review, the licensee did not comply with the section cited above in 1 out of 5 file reviews staff member Angelique Hall did not have immunization records availble for review, which poses a potential health risk to persons in care.
POC Due Date: 12/31/2021
Plan of Correction
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Staff member shall provide proof of immunization for Pertussis, Measles and Influenza by the due date of 12/31/2021 or prior to returning to work. The center shall provide photo copies to the department no later than the due date or when staff member returns
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Peter Flores
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2021


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