198400839-8-30-2023-54-CC-TTRN-CV7REQ-20230830125754

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400839
Report Date: 08/30/2023
Date Signed: 08/30/2023 12:58:05 PM

Document Has Been Signed on 08/30/2023 12:58 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	NLMUSD-COLUMBIA EARLY LEARNING		FACILITY NUMBER:	198400839
ADMINISTRATOR:	PARKER, LAUREL		FACILITY TYPE:	850
ADDRESS:	12830 COLUMBIA WAY		TELEPHONE:	(562) 803-6229
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 115	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/30/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Loretta Gallegos		TIME COMPLETED:	01:15 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	About 8:40AM, Licensing Program Analyst (LPA), T. Tran conducted an announced visit at 12830 Columbia Way Downey, CA 90242 to conduct a prelicensing inspection for the change of ownership. Upon arrival, LPA met with the Loretta Gallegos, Assistant DIrector. Then we toured and measured all the indoor and outdoor space. The facility is requesting to serve for the maximum capacity of 115 children, 51 preschool with 64 toddler option attached. Fire clearance was granted and obtained for the capacity requested. The hours of operation from 7:55 AM - 3:00 PM, Monday through Friday. For the preschool program, the facility have sufficient indoor and outdoor space with toilets and sinks to accommodate 51 preschooler. For the toddler option, the facility have sufficient indoor with toilets, sink, and changing table to accommodate 64 toddlers but outdoor space can only accommodate 52 toddlers. Facility will submit an outdoor waiver request toddler option. Each component has its own separate physical space for indoor and outdoor. LPA inspected and measured all areas specified on the facility sketch. There are age-appropriate furniture and equipment observed in each classrooms which appear to in a good condition. The classrooms running water available and accessible to children. There are dispensable soap and paper towels in the children's restroom. Cubbies are available for children's belongings. Napping equipment (cots) were observed. Per facility children bring their own linens from home. Linens will be given back to the parents to take home every Friday to be washed. Children's linens are to be stored individually. Isolation area belongs in each classroom. If needed on the the children's restroom will be the designated restroom for ill children. First aid supplies are available. Carbon monoxide detectors and smoke detectors are present and in operable condition. Fire extinguisher (2A-10BC) was fully charged. The facility provides breakfast, lunch, and snack. Food items will be delivered daily from school district main kitchen. Facility shall ensure that food is age appropriate and follows Federal Food Guidelines. Food is prepared in the kitchen. Kitchen area includes a refrigerator, a sink has running water. Cabinets are available for storage and free from cleaning compounds. Outdoor physical space were completely fenced. Playground equipment are in safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space were well maintained. Outside has good shade area. No bodies of water observed on the premises.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NLMUSD-COLUMBIA EARLY LEARNING	FACILITY NUMBER: 198400839
	VISIT DATE: 08/30/2023

NARRATIVE

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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
Required Postings/Licensee shall have posted in the Child Care Center at all time the following:
Facility license.
Personal Rights form (LIC 613A).
Menus.
Child passenger restraint system poster. (PUB 269).
Daily activity schedule.
Emergency Disaster Plan (LIC 610) and Earthquake Preparedness Checklist (LIC 9148).
Parent’s Rights Poster (PUB 393).
Notice of Site Visit (LIC 9213).
Any licensing report documenting a type “A” citation must be posted for 30 days.
Any licensing report or other document verifying compliance or non-compliance with the Department’s order to Correct a Type A deficiency must be posted for 30 days
Children's Records are to be maintained by the facility and must contain the following:
Identification and Emergency Information - Child Care Centers (LIC 700).
Child's Preadmission Health History - Parents’ Report (LIC 702).
Child's Preadmission Health Evaluation if not enrolled in a public or private elementary school - Physician's Report (LIC 701).
Consent for Medical Treatment (LIC 627).
Written statement from parent(s) or authorized representative exempting child from medical assessment, immunizations, and treatment because of adherence to a religious faith that practices healing by prayer or other spiritual means; or physician's statement that immunization is not indicated.
California School Immunization Records (“blue cards”, PM 286) for non-school-age children.
Current Admission Agreement, with authorized signature(s).
Centrally Stored Medication and Destruction Record (LIC 622), if medications are handled.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NLMUSD-COLUMBIA EARLY LEARNING	FACILITY NUMBER: 198400839
	VISIT DATE: 08/30/2023

NARRATIVE

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Documentation of unusual behavior or signs of illness, special needs.
Unusual Incident/Injury Report (LIC 624).
Signed and dated receipt of Notification of Parents’ Rights (LIC 995).
Personal Rights — Community Care Facilities, Child Care Facilities (LIC 613A) receipts, signed and dated.
Authorizations for dispensing medication, signed by each child’s authorized representative.
Documentation required for health-related services, if needed (e.g., blood-glucose monitoring and nebulizer care).(LIC 9166). Gastrostomy Tube Care: Physician’s Checklist (LIC 701A). Acknowledgement of receipt of licensing reports (LIC 9224), if applicable.
Licensee shall maintain Administrative Records which shall have the following:
Written inspection procedures for accepting children on a daily basis.
Sign-in/sign-out sheets kept for current 30 days, or approved waiver to use electronic pin system.
Admission policies, including admission criteria, ages of children who will be accepted; medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any.
Designation of Facility Responsibility (LIC 308).
Personnel Report (LIC 500) showing current roster.
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months. Documentation of drills shall be maintained for at least one year.
Up-to-date list of qualified teacher substitutes.
Documentation of exceptions and waivers: Facility Waiver Request (LIC 956) and Exception/Exemption Request (LIC 971).
Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). And a Child Care Facility Roster (LIC 9040).
The licensee was informed about the Healthy Schools Act and the required training to be completed.
Senate Bill 792 was discussed pertaining the requirement of immunization for staff working at childcare
LPA recommended facility to stay updated with information related to Covid-19 from the California Department of Public Health (CDPH) guidelines, including Centers for Disease Control and Prevention (CDC) guidelines to help prevent and protect staff and children in care.
LPA informed the effects of lead exposure for children between ages 1-6 years old are the most at risk for lead poisoning. A copy of lead exposure was provided.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NLMUSD-COLUMBIA EARLY LEARNING	FACILITY NUMBER: 198400839
	VISIT DATE: 08/30/2023

NARRATIVE

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LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations and PINs. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.
Facility was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Facility is reminded that smoking is prohibited on the premises.
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. 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.

As of 8/30/23, The license will be granted to serve 51 preschool children with 64 toddler children option attached to the preschool license for the capacity of 115 children.

Exit interview conducted and report was reviewed with the facility representative, Loretta Gallegos.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC809 (FAS) - (06/04)

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