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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012843
Report Date: 11/04/2022
Date Signed: 11/04/2022 03:16:38 PM

Document Has Been Signed on 11/04/2022 03:16 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:WILL ROGERS PRESCHOOLFACILITY NUMBER:
198012843
ADMINISTRATOR:NATTALY ZAVALAFACILITY TYPE:
850
ADDRESS:11220 DUNCAN AVENUETELEPHONE:
(310) 603-2087
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 24TOTAL ENROLLED CHILDREN: 42CENSUS: 16DATE:
11/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Cindee Kim, TeacherTIME COMPLETED:
03:30 PM
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An unannounced Required – 1 Year Inspection was conducted on 11/04/2022 at 11:55 AM by Licensing Program Analyst (LPA) Katrina Chicote. Facility is currently licensed for a capacity of 24. Licensing staff met with Cindee Kim, Teacher. This program currently operates two programs an AM program from 8:00 AM to 11:00 AM and a PM program from 11:45 AM to 2:45 PM Monday thru Friday. There is a full day program located in the same building with separate facility #191570889. Facility is made up of a single classroom, RM 1, at Will Rogers Elementary School Campus. LPA singularly toured the facility both indoors and outdoors. LPA did not observe License, PUB 269, LIC613A posted at time of inspection. LPA provided documents to post and LIC125 to Facility Representative (FR).

At the initial start of the site visit, there is a total census of 16 children and a total census of three teachers (S1, S2, and S3) present.

Beginning at 12:00 PM, furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated.There were cubbies observed as storage for children's belongings. LPA observed child size tables and chairs (Lakeshore Brand) available for children in classroom well maintained and floors to be free of hazards at time of inspection. LPA observed learning stations for Dramatic Play , Math Manipulatives, Art, and Science available for children with shelves filled with toys free of loose and sharp parts. LPA observed a library and quiet seating area available for quiet play. Due to part time programs, facility does not offer nap time. Availability of drinking water was reviewed. Per FR, children use water fountain available in classroom. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. LPA observed two bathrooms available in classroom with one toilet each totaling two toilets, and three sinks available in the classroom.
Report Continues - Page 1 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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 7
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: WILL ROGERS PRESCHOOL
FACILITY NUMBER: 198012843
VISIT DATE: 11/04/2022
NARRATIVE
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LPA observe first aid kit is hung on wall in classroom and inventoried for supplies. At 12:02 PM, carbon monoxide detectors were observed operable and smoke detectors are present in the facility. Fire extinguishers have been serviced in 10/25/2022. LPA observed facility's sick/isolation area is in nearby Preschool Office. Per FR, there are no children that require medications in the classroom at this time. Hazardous items including poisonous cleaning compounds were stored inaccessible to children.

Snack/lunch menus were reviewed. Facility provides each program a lunch that is provided by nearby elementary school campus. LPA observed S2 pick up lunch from cafeteria and bring it to classroom. Trash cans used to discard food have tight fitting lids.

Beginning at 12:05 PM, outdoor equipment was inspected for safety, cushioning material, good repair and age-appropriateness. LPA observed a large play structure with climbing steps and slide with cushioning material below to absorb fall all well maintained. Required shade and fencing were inspected. LPA observed benches under covered shade in outdoor play area. LPA advised FR that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to drinking fountains during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water were observed. LPA observed a circular hole in the black asphalt of surface of outdoor play area large enough for a child's foot during inspection.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Per FR, facility has recently moved to electronic sign in procedures earlier this week. LPA observed all 16 children present signed in on electronic app. Personal Rights of children were observed by LPA.

Beginning at 1:20 PM, staff and children’s records were reviewed. Children’s Records were reviewed for completeness. Inspection of required forms was made and documented on the LIC 857. The review of Staff records was documented on the LIC 859.
Report Continues - Page 2 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: WILL ROGERS PRESCHOOL
FACILITY NUMBER: 198012843
VISIT DATE: 11/04/2022
NARRATIVE
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Staff present did have proof of the AB 1207 Mandated Reporter Training certificate on file. LPA observed Pediatric First Aid/CPR expires on 02/2024 for S1. LPA did not review confidential staff files during the inspection due to the staff confidential files being stored at the administrative office. All staff and employees have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Lynwood Unified School District.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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 this information, the following deficiencies on the attached LIC 809D 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. Advisories were also given during this visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Cindee Kim.
Report Ends - Page 3 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 11/04/2022 03:16 PM - It Cannot Be Edited


Created By: Katrina Chicote On 11/04/2022 at 01:30 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: WILL ROGERS PRESCHOOL
FACILITY NUMBER: 198012843

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, surface area was not maintained as LPA observed a circular hole on floor of black asphalt big enough for a child's foot to fit in that is a tripping hazard. This is a potential health, safety, and personal rights risk to children in care.
POC Due Date: 12/04/2022
Plan of Correction
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FR states she will put in work order today and provide proof of work order and photo once it's done by POC date via email.
Type B
Section Cited
CCR
101217(a)(6)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (6) Documentation of the educational background, training and/or experience specified in this chapter.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA did not observe any educational background documents, either Child Development Permit or transcripts, for S2 during file review. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 12/04/2022
Plan of Correction
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FR states she will obtain documents and provide proof to LPA by POC date via email.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022


LIC809 (FAS) - (06/04)
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