198010922-3-18-2024-54-CC-AMOY-D3GSXD-20240318141547

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010922
Report Date: 03/18/2024
Date Signed: 03/18/2024 02:16:06 PM

Document Has Been Signed on 03/18/2024 02:16 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:	CUDAHY PRESCHOOL ACADEMY		FACILITY NUMBER:	198010922
ADMINISTRATOR:	ADOL VERGARA		FACILITY TYPE:	850
ADDRESS:	4912 CLARA ST		TELEPHONE:	(323) 771-8700
CITY:	CUDAHY	STATE: CA	ZIP CODE:	90201
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 43	CENSUS: 30	DATE:	03/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Adol Vergara, Site Supervisor		TIME COMPLETED:	02:30 PM

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Licensing Program Analysts(LPA) Alicia Mooberry and Jonnisha Culbert conducted an unannounced Annual - Random inspection to the above facility. Upon arrival LPAs met with Adol Vergara, Site Supervisor, and informed of the purpose of this inspection. The Site Supervisor provided a tour of the facility. LPA provided the LIC 125 Entrance Checklist upon arrival. This facility is located in the campus of a church building. The facility has three preschool classrooms. Classroom C-2 and B-7 are used for full day program. Classrooms B-6 is used for part time and full time sessions. The facility operates from Monday through Friday and is open from 8:00AM to 4:00 PM. The following census was taken, Room C2: LPAs observed fourteen (14) children supervised by three (3) staff, Room B-7: LPAs observed twelve (12) children and two (2) staff, Room B-6: LPA's observed four (4) children supervised by one (1) staff. All staff present have obtained criminal record clearance. Sign-in sheet were reviewed, all children present were signed in.

Per Site Supervisor, there are 43 children currently enrolled. The Isolation area for children who are ill is in the director's office. Per Site Supervisor, the staff bathroom is located on the church building inaccessible to children in care.

During inspection LPA observed age appropriate toys and equipment. Lighting was in operable condition. Children's individual storage space was inspected. There is accessible filtered drinking water in each classroom by a dispenser and disposable cups.

Facility Representative was reminded to to post Meal/Snack menus at least one week in advance. The facility provides AM and PM snacks and lunch. The facility prepares meal on site. Food items were reviewed for availability, quantity, expiration dates and appropriateness for children in care. LPA observed the snack storage area (kitchen) appear to be in sanitary condition. LPA informed Site Supervisor to constantly assess expiration dates on food items that are removed from original packaging and document original source.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUDAHY PRESCHOOL ACADEMY	FACILITY NUMBER: 198010922
	VISIT DATE: 03/18/2024

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Appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, and general sanitation. The restrooms located in the classrooms were observed to be clean and in operable condition.

There cleaning agents are located in container on counter that is not in proximity to food preparation area. and in locked cabinet under sink in kitchen area.

First Aid supplies were observed. Disinfectants, cleaning solutions, and other dangerous items to children, were inaccessible. There are no poisons stored at the facility.

The outdoor play area was inspected for hazards and inaccessibility to bodies of water. LPAs observed a wooded playhouse used by children that has chipping paint and wood pieces, this poses a potential risk to the health and safety of children in care. The outdoor play area is located in a fenced off area across the parking lot. LPAs observed that the fenced off area has been divided by a 3 foot fence separating and empty lot and play area with toys and equipment. Per Facility representative, the children only play in the area of the yard that has the toys and equipment. The Facility Representative was reminded to ensure the entire fenced area is kept free of hazards unless a 4 foot fence is built to divide the empty lot and play area. There is appropriate shading equipment, benches and toys. All play equipment, toys, materials and surfaces accessible to children appear to be age appropriate and toxic free. Drinking water is available by a dispenser and disposable cups.

Per Director, there are currently no children that require medication administration. 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

There is at least one person with the required EMSA approved Pediatric CPR and First Aid present during this inspection.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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: CUDAHY PRESCHOOL ACADEMY	FACILITY NUMBER: 198010922
	VISIT DATE: 03/18/2024

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LPAs reviewed Children and Staff records. The review was documented on the LIC 857 and LIC 859.

Facility Representative 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 verified that the lead testing was completed and in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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

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/tion-process.

Exit interview was conducted with Site Supervisor Adol Vergara and a copy of Appeal Rights (LIC 9058) was discussed and provided

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

Exit interview conducted and report was reviewed with Director, Adol Vergara. Appeal rights were discussed and a copy provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/18/2024 02:16 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 03/18/2024 at 01:23 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: CUDAHY PRESCHOOL ACADEMY	FACILITY NUMBER: 198010922
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101239(o)(1)

Fixtures, Furniture, Equipment and Supplies

(o) Playground equipment shall be securely anchored to the ground unless it is portable by design. (1) Equipment shall be maintained in a safe condition, free of sharp, loose or pointed parts. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that a play house in children's play area was observed to have wood that is deteriorating including chipped paints and splinters which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/05/2024
	Plan of Correction
1 2 3 4	Per Site Supervisor the play house will be removed and a photo of the correction will be sent to LPA by POC due date.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC809 (FAS) - (06/04)

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