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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019623
Report Date: 04/04/2025
Date Signed: 04/04/2025 09:34:31 AM

Document Has Been Signed on 04/04/2025 09:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GRIFFIN AVENUE HEAD START/PRESCHOOLFACILITY NUMBER:
198019623
ADMINISTRATOR/
DIRECTOR:		KENICIA MOTAFACILITY TYPE:
850
ADDRESS:2025 GRIFFIN AVETELEPHONE:
(323) 222-8131
CITY:LOS ANGELESSTATE: CAZIP CODE:
90031
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
04/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Leticia Rodriguez, Site Supervisor TIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On April 4, 2025, Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced annual inspection. Upon arrival LPA met with Leticia Rodriguez, Site Supervisor. LPA provided a copy of the Entrance Checklist for Child Care Centers form (LIC 125). LPA was led on a tour of the facility. This is an LAUSD Head Start preschool program located in RM 5 on the premises of Griffin Elementary School. This program consists of 1 classroom. The facility has a waiver on file. Waiver indicates the sharing of the outdoor play space. LPA observed waiver to be posted. Leticia Rodriguez guided LPA on a tour of the facility. There were 10 children present at the time of the inspection. The Head Start program currently provides a partial day program in Room #5 from 8:10AM-12:05PM, Monday to Friday. Per Leticia Rodriguez, there are currently 15 enrolled in the program.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection; Room #5: 3 Staff with ten (10) preschoolers. The facility was observed to be within the license capacity and limitations. The following was observed during the tour of the facility:

Licensing staff observed all required forms/publications to be posted by the front door of the classroom. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Facility provides breakfast, lunch and snacks.

The following classrooms were inspected: Room #5. Teacher -child ratios were observed to be in accordance with Title 22 regulations. All children were observed to be under visual supervision of a teacher during tour.

Napping equipment was not observed due to facility not napping. Storage for children's belongings were inspected. Children have their own cubby to store their belongings. First Aid supplies are available and complete. Age-appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classrooms via a

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIFFIN AVENUE HEAD START/PRESCHOOL
FACILITY NUMBER: 198019623
VISIT DATE: 04/04/2025
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water dispenser.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Leticia Rodriguez, Site Supervisor, stated there are no poisons stored at the facility. Carbon monoxide detectors were observed and are operable and smoke detector that meets statutory requirements. Fire and smoke detectors are hard wired, and LPA observed the flashing light indicating its active and ready. Per Leticia Rodriguez, Site Supervisor it is operable.

The food storage/preparation area is kept clean and free of litter, rubbish, rodents, or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded. All food in fridge were observed to be labeled. All floors are clean and safe. The facility was observed to be free of flies, other insects, and rodents.

At this time, the Nurses office located in the main office is used as an isolation area, there is a bed available for an ill child to rest and a restroom if needed.

Licensing staff Perry observed the valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced 3/13/2025 as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Lead Teacher states there are no weapons, firearms, or bodies of water on the premises.

LPA Perry reviewed the outdoor play area. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. There is one outside play space that has one play structure with a manufacture label indicating the ages of 2-5 years old. Drinking water is readily available outdoors. LPA advised Leticia Rodriguez, Site Supervisor that the children need to be within the direct care and supervision at all times. Leticia Rodriguez, Site Supervisor stated that they take a jug of water with them outside with small disposable cups when they go outside to play.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Disaster drills have been conducted at least every six months. Last drill conducted was on 3/7/2025.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GRIFFIN AVENUE HEAD START/PRESCHOOL
FACILITY NUMBER: 198019623
VISIT DATE: 04/04/2025
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There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPA reviewed children files; files were found to be complete. LPA reviewed staff files; files were found to be complete. Inspection of required forms was made and documented on the LIC 857.

IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Testing was conducted and results were provided to LPA. Licensing staff referred site supervisor to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Leticia Rodriguez, Site Supervisor 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Leticia Rodriguez, Site Supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview conducted, Appeal rights were discussed and provided and report was reviewed with Leticia Rodriguez, Site Supervisor .

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC809 (FAS) - (06/04)
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