Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018196
Report Date: 03/06/2017
Date Signed 03/06/2017 01:22:31 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S COLLECTIVE INC - MAPLE STREET, THEFACILITY NUMBER:
198018196
ADMINISTRATOR:CHENIEKA MORGAN-MILLSFACILITY TYPE:
850
ADDRESS:255 EAST 28TH STREETTELEPHONE:
(310) 733-4388
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:36CENSUS: 29DATE:
03/06/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Director Loretta IberosiTIME COMPLETED:
01:30 PM
NARRATIVE
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AN ANNUAL REQUIRED INSPECTION WAS CONDUCTED IN ENGLISH
Licensing Program Analyst (LPA) Ariel Cazares conducted an unannounced annual required inspection. LPA met with Director Loretta and guided on a tour of the facility by the director. There were 29 children present and two additional staff during the inspection.

LPA toured the areas according to the facility sketch on file and inspected all areas. No alterations have been made. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are taken home each Friday to be washed. Napping equipment (cots) were observed in a separate storage room near children's cubbies. Per director, the isolation restroom is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. Smoke and carbon monoxide detectors are located in the classroom and are in operable condition. Availability of indoor drinking water was observed in classroom via a jug and disposable cups.

First Aid supplies can be found in the office next to the classroom. According to director, medication is not administered at this time and not stored in the facility.

The outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade and fencing were inspected. Outdoor play yard has water jug and disposable cups. Per Director, lunch and snacks are brought from an outside vendor. Children do not provide their own snacks or lunches.

SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323)896-6849
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2017
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S COLLECTIVE INC - MAPLE STREET, THE
FACILITY NUMBER: 198018196
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2017
Section Cited
101229.1(a)(1)
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Sign In and Sign Out

The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. LPA observed that signatures were missing next to times noted on sign in and out sheets.
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Per Director, will speak to parents and post a reminder notice or provide letter to sign in and out completely with signatures. Copy of this notice will be sent to LPA by POC due date.
Type B
03/16/2017
Section Cited
101216(g)(2)
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Personnel Requirements.

All personnel including the licensee shall have a health-screening report, including specified information, signed by the person who performed it. Staff #1 and 2 are missing health screening on file.
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Per Director, will submit copies of health screenings once obtained to LPA by POC due date.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323)896-6849
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2017
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S COLLECTIVE INC - MAPLE STREET, THE
FACILITY NUMBER: 198018196
VISIT DATE: 03/06/2017
NARRATIVE
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Food and snacks menu was reviewed for availability and appropriateness to children in care and is posted in the facility at the entrance. Children are provided up to two snacks a day. Teacher child ratios were observed to be in compliance. Care and supervision was evaluated to determine if the basic needs of children are met. All children are adequately supervised. LPA advised Director of Department updates and changes.

LPA also reviewed fingerprint clearances, children and staff records. Sign in and out sheets were reviewed. LPA observed sign in and out sheets to not reflect children who were present. LPA observed some sign in and out sheets to have times noted for children but no signatures to correspond with that date and time. LPA also observed times and signatures noted on future dates.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

See attached deficiencies page for citations in accordance with Title 22 California Code of Regulations.

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted with Director Loretta Iberosi. Appeal rights provided and explained.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323)896-6849
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2017
LIC809 (FAS) - (06/04)
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