Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417849
Report Date: 12/28/2016
Date Signed 12/28/2016 03:20:39 PM

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:CARDEN DOMINION SCHOOL, INC.FACILITY NUMBER:
197417849
ADMINISTRATOR:SCOTT, TERRIFACILITY TYPE:
850
ADDRESS:706 KNOB HILLTELEPHONE:
(310) 316-9733
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY:56CENSUS: 18DATE:
12/28/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Terri Scott/Director TIME COMPLETED:
03:17 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 Analyst (LPA) Trevino Cochran conducted an unannounced annual random site inspection. LPA met with Center Director, Terri Scott. LPA inspected the inside and outside of the facility.

A total of 18 children and 4 teachers were present during the inspection. Classroom #1 LPA observed at a ratio of 9 napping children (ages 2-6 years old) to 2 teachers supervising. Classroom #2 was observed on playground outdoors with a ratio of 9 children (ages 2-6 years old) to 1 teacher. The facilities program has 3 classrooms for learning and active play. Furniture and equipment were inspected for age appropriateness and good repair in each classroom. Telephone service, heating, lighting and ventilation were evaluated. LPA observed individual cubbies for children's belongings. The facility uses the directors office as an isolation area when children are sick. Age appropriate sinks and toilets were inspected for availability and good repair. LPA observed changing table in restroom (attached to wall) without padding (see 809D). LPA observed cleaning supplies in an accessible area that could pose an immediate danger to children(see 809D). Toilet paper, paper towels were observed inside the restroom. First Aid supplies, smoke detectors, carbon monoxide and fire extinguishers were observed.

LPA observed cots with sheets for napping in each classroom.

The center does not provide snacks for children. Parent's must provide lunch and snack daily. Water is available inside the classrooms. Teachers also take a pitcher of water and cups outdoors.

Fire and disaster drills are conducted monthly.

Children and Staff files were complete with all required CCLD forms. The facility roster was up to date and all staff have been fingerprinted and associated to the designated license number. Director and teachers are currently certified in pediatric first aid and CPR which expires on 2/2017.

SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2016
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


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: CARDEN DOMINION SCHOOL, INC.
FACILITY NUMBER: 197417849
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2016
Section Cited
101439(h)(1)
1
2
3
4
5
6
7
Infant Care Center Fixtures, Furniture, Equipment and Supplies.
Infant changing tables shall: Have a padded surface no less than one-inch thick and be covered with washable vinyl or plastic.
1
2
3
4
5
6
7
LPA observed changing table in restroom without padding according to Title 22 Regulations. Director stated facility will purchase padding for changing table and email picture to LPA no later than 1/6/2017.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2016
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CARDEN DOMINION SCHOOL, INC.
FACILITY NUMBER: 197417849
VISIT DATE: 12/28/2016
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
26
27
28
29
30
31
32
There were no bodies of water observed in the playground area. The outdoor playground was inspected and was observed to be free of hazards, loose and sharp parts. LPA did observe large trees that provide enough shade. The playground was observed to be properly gated all around. Equipment was inspected for safety, cushioning material, good repair and age appropriateness.

The following forms were observed to be posted. The facility license, Parent's Rights Poster (PUD 393), Personal Rights (LIC 613A), Emergency Disaster Plan (LIC 610).

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For additional information and forms visit our website at: www.ccld.ca.gov


A copy of this report must be made available to the public for 3 years.

The facility was not in compliance per Title 22 regulations, Type A and B deficiencies will be cited today 12/28/2016.

An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: CARDEN DOMINION SCHOOL, INC.
FACILITY NUMBER: 197417849
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/28/2016
Section Cited
101238(g)
1
2
3
4
5
6
7
Buildings and Grounds. Disinfectants, cleaning solutions, and other items that are dangerous to children shall be inaccessible to children. LPA observed cleaning supplies on table and accessible to children.
1
2
3
4
5
6
7
Corrected during visit. Teacher moved cleaning supplies to area that was inaccessible to children. Director stated all cleaning supplies will be locked in cabinet in adult restroom on site. Director stated will discuss in next staff meeting in January 2017. Director will email meeting agenda to LPA.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4