Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417385
Report Date: 08/28/2015 12:00:00 AM
Date Signed 08/31/2015 09:47:27 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:DEVONSHIRE PRESCHOOL AND INFANT CENTERFACILITY NUMBER:
197417385
ADMINISTRATOR:MARINA CASTELLANOSFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:43CENSUS: 19DATE:
08/28/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lorell ButterworthTIME COMPLETED:
10:30 AM
NARRATIVE
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Margarit Sislyan, Licensing Program Analysts met with Lorell Butterworth, facility director for the purpose of an Annual Random Visit in accordance with CCR Title 22 Division 12 Chapter 1, governing Child Care Centers. LPA Sislyan toured the facility, all identified rooms per facility sketch were inspected, and the following was observed:
Furniture & Equipment age appropriate and in good repair:
No Baby walkers on premises
High chairs or feeding tables have broad-based legs. Plastic seats in good repair
Sanitary solution out of infant reach.
Changing tables have at least 1 inch thick padding covered with washable vinyl or plastic. Sides raised a minimum of 3 inches. Changing table within arm’s length of sink when in use.
Caregivers wash hands before and after each feeding and each diaper change.
Toys safe, with no sharp edges, splinters or points, nor made of small parts that can be pulled off and swallowed.
Cribs or other appropriate napping equip available for each crib age infant
Bedding separately identified and stored for each infant
Placement of cribs, cots or mats allows for entry/exit from the napping space
Play area was observed to be free of debris. Play area was inspected for hazards and inaccessibility to bodies of water.

A review of the sign in/out sheet was conducted to verify the current census of children. Currently there are 19 children. The child teacher ratio was in compliance. Facility is operating within capacity limits.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2015
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: DEVONSHIRE PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 197417385
VISIT DATE: 08/28/2015
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Children are inspected for illnesses as they are picked up from their class. Most ill children are sent home prior to the end of the school day. A review of medication policy indicated that prescription and over the counter medication is administered and only with parent's written permission and doctor's note. The facility director administers the medication and documents the dosage, date and time onto a log. There is a separate area for isolation and care of ill children in the office. There is a mat and blanket available for each ill child.
The food is provided by parents, it is properly labeled and stored in a separate baskets.
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 were reviewed. The parent board was reviewed and has all of the required forms posted.
Children's records were reviewed and observed to be complete. All staff certified in Pediatric CPR and First Aid. LPA informed the director forms and a copy of Title 22 Regulations may be obtained at the department's website www.ccld.ca.gov.INcidental

Medical Incidental Services were discussed.

No deficiencies cited according to Title 22 Regulation
A copy of this report must be available to the public, at the facility site for 3 years.
An exit interview was conducted.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2