198019444-2-2-2023-54-CC-DGIS-CNNVFM-20230202152341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019444
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:24:24 PM

Document Has Been Signed on 02/02/2023 03:24 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:	ANNALEE AVE ELEMENTARY PRESCHOOL		FACILITY NUMBER:	198019444
ADMINISTRATOR:	EMILY BARBEE		FACILITY TYPE:	850
ADDRESS:	19410 ANNALEE AVE		TELEPHONE:	(310) 537-4740
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY: 22	TOTAL ENROLLED CHILDREN: 22	CENSUS: 10	DATE:	02/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Emily Barbee, Facility Representative		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 2/2/23 at 13:35 PM. LPA met with Emily Barbee, Facility Representative (FR). There were 10 children and three staff present when LPA arrived. This is a preschool program that operates a full day program on the Annalee Elementary campus in Room #K3 from 8AM to 2:30PM. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. At 12:45 PM LPA toured Classroom (K-3). LPA observed that furniture and equipment is maintained in good condition, free of loose, sharp and/or pointed parts. The floors of the classroom have surfaces that are safe and clean. Drinking water is made readily available for the children via individual water bottles provided by the facility. LPA observed extra water bottles in the cabinet. LPA observed children napping on cots. Children bring bedding from home to be washed weekly on Fridays. Per staff, they do not have extra bedding on hand. LPA observed two children without sheets covering their cots. LPA observed multiple cobwebs and a sticky substance in the cabinets under the sink where children wash their hands. Per FR, there are no children currently on medication. There are no weapons or firearm on the facility premises. LPA did not observe required posted documentation, which includes, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System and LIC 613A- Notification of Parent’s Rights and cafeteria Menu. All documents were provided to FR during inspection. At 12:55 LPA toured the children’s restroom. Restroom is located in the classroom. LPA observed a door that leads to the Transitional Kindergarten classroom. A waiver is on file for shared restroom use. Waiver was provided to FR. Restroom was observed to be safe and sanitary with operable sinks and toilets. ---------PAGE 1

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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 10

Document Has Been Signed on 02/02/2023 03:24 PM - It Cannot Be Edited

Created By: Denise Gibbs On 02/02/2023 at 02:32 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: ANNALEE AVE ELEMENTARY PRESCHOOL	FACILITY NUMBER: 198019444
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. 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. Cobwebs and a sticky substance was observed in the cabinets under the children's hand washing sink, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2023
	Plan of Correction
1 2 3 4	Per FR, the plant manager will clean out the cabinet and she will email a picture by POC date 2/28/23

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 out of 3 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2023
	Plan of Correction
1 2 3 4	Per FR, She will have staff take the training and email certificate by POC date 2/28/23.

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:

Denise Gibbs

LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 6 of 10

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: ANNALEE AVE ELEMENTARY PRESCHOOL	FACILITY NUMBER: 198019444
	VISIT DATE: 02/02/2023

NARRATIVE

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Sign In/Out sheets located in the classroom. Due to COVID-19 precautions parents still drop XXXX, the teacher who receives the child is signing the child in and the parent signs them out at the end of the day. All children present were signed in with date, time and full signature of guardian/teacher.

At 1:00PM LPA toured the outdoor play area. Waiver is on file for shared outdoor space. Preschools shares yard with the TK program. Waiver was provided to FR for posting. Staggered play schedule was observed so children do not commingle. Toys and material are taken outdoors when children go outdoors. Shade was observed throughout the outdoor area via building awnings. LPA observed operable water fountains so children can drink freely.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 1/13/23. Items were observed.

Children’s records were reviewed for Emergency Card, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All children's records were complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, Licensing Form (LIC) 9052- Employee Rights, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts or Permit for qualified teacher and current Mandated Reporter Training Certificate (AB1207).

Facility provides AM snack, PM snack and lunch. Food is not cooked at the facility. Prepackaged food is delivered daily. Kitchen was observed to be clean, free of litter, insects and rodents. LPA observed trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food. Facility carbon monoxide detector is wired with the smoke and fire alarm. Required water water lead testing has been completed and corrections have been made. LPA has received all required documents.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 10

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: ANNALEE AVE ELEMENTARY PRESCHOOL	FACILITY NUMBER: 198019444
	VISIT DATE: 02/02/2023

NARRATIVE

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Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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 Center 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

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.

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 Emily Barbee.

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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