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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004424
Report Date: 09/22/2022
Date Signed: 09/22/2022 06:09:55 PM

Document Has Been Signed on 09/22/2022 06:09 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:COVENANT KIDS PRESCHOOLFACILITY NUMBER:
198004424
ADMINISTRATOR:DANDY DEPAULAFACILITY TYPE:
850
ADDRESS:21209 S. CLARETTATELEPHONE:
(562) 402-8330
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY: 48TOTAL ENROLLED CHILDREN: 11CENSUS: 9DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Melissa Maravilla, Interim DirectorTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alicia Mooberry and Austin Estrada conducted an unannounced Required Annual Inspection. LPAs met with Melissa Maravilla, Interim Director (Director), who provided a tour of the facility. Per Director, the hours of operation are Monday - Friday 7am to 5PM. The facility has two classrooms where care is provided. LPAs observed 9 children supervised by the Director and Staff 2 in the Butterfly Classroom. Dandy DePaula, arrived during this inspection. Teacher child ratios were observed and staff names recorded. The following was observed during the tour of the facility:

Sign-in sheets were reviewed, 1 of 9 children present were not signed in, posing a potential risk to the safety of children in care. The two classrooms were inspected for cleanliness and good repair. The carpets were clean and lighting was in operable condition. There were age appropriate toys and equipment. Children's individual storage space was inspected. There are first aid kits in each classroom

Per Director the Isolation area for ill children is the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. LPAs observed and tested carbon monoxide detector and a smoke detector.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director states that there are no poisons stored at the facility.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. The cafeteria room, next to the kitchen is used for meetings and meals. LPA inspected the food preparation area and refrigerator and observed it to be clean and in operable condition. This space is also shared with the church. LPA observed items in the refrigerator with expiration dates including eggs and apple sauce. Per interim director, the expired items do not belong to the daycare and will be removed.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 09/22/2022 06:09 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 09/22/2022 at 12:31 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: COVENANT KIDS PRESCHOOL
FACILITY NUMBER: 198004424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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
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Based on observation, the licensee did not comply with the section cited above due to a wooded stick (approximately 12 inches) with rusty nails was found on the ground of desiganted children's play area which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2022
Plan of Correction
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The Director removed the stick with nails from the play area immediately and stated they will check the playarea prior to children playtime to ensure there are no hazardous items.
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022


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Document Has Been Signed on 09/22/2022 06:09 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 09/22/2022 at 12:31 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: COVENANT KIDS PRESCHOOL
FACILITY NUMBER: 198004424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

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 2 records reviewed had Mandated Reporter certificate on file which expired on 07/21 poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Per Director, Staff #2 will complete the Mandated Reporter (AB1207) training and copy of certificate will be sent department via email by POC due date.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 9 children present were not signed in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Per Director, the sign in sheet will be completed on this date and all children will be signed in copy of the completed sign in sheet will be sent department via email by POC due date. Per Director, the staff will ensure parent sign in children when dropped off.
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022


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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COVENANT KIDS PRESCHOOL
FACILITY NUMBER: 198004424
VISIT DATE: 09/22/2022
NARRATIVE
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There is a fireplace in the cafeteria that, Per Director, is not utilized whatsoever and it mainly serves as a decoration. A signed declaration was previously obtained stating that the fireplace is never used. LPA advised the director to make the fireplace inaccessible to children in care.

Clean bottled drinking water and disposable cups provided to children in the classroom. Children have water bottles that they can fill to take outdoors. Medication is not administered to children in care.

Restrooms used by children were observed to be clean and in operable condition. Per Director, the children are always supervised when they used the restroom.

Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. LPAs observed, a wooded stick (approximately 12 inches) with rusty nails was found on the ground of designated children's play area which poses an immediate health, safety or risk to persons in care. The item was removed immediately.

Napping equipment and bedding were inspected. The linens are are washed weekly by staff or as needs. Inspection was conducted for appropriate storage and cleanliness of children's blankets and personal items.



Lead Poisoning Facts Flyer (PUB 515) – All licensees (Child Care Centers) must provide the following flyer to parents and families upon enrolling or re-enrolling any child. PIN 21-21-CCP: Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers Per AB 2370
6. PIN 22-06-CCP: Lead Testing in Child Care Center – Frequently Asked Questions
7. Lead Testing in Child Care Centers Frequently Asked Questions (regarding your questions, please refer to Q23, Q24, Q29, Q34, and PIN 21-21-CCP)

Please visit the Lead Toxicity Prevention and Water Testing Information website for additional information and resources regarding lead testing in licensed child care centers by visiting the following weblink: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

For any additional questions, please email: CCCWaterTesting@dss.ca.gov.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COVENANT KIDS PRESCHOOL
FACILITY NUMBER: 198004424
VISIT DATE: 09/22/2022
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There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed. Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff 2 did have proof of the AB 1207 Mandated Reporter Training certificate on file.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


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 [or 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. The Director was provided with LIC 9224 Parent Acknowledgement of Report Received.

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

Exit interview conducted and report was reviewed with the Director Melissa Maravilla

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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