191202451-7-12-2019-33-CC-JDOY-BDZQG4-20190712120854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202451
Report Date: 07/12/2019
Date Signed: 07/12/2019 12:09:01 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:	LAKE AVENUE CHURCH NURSERY SCHOOL, THE		FACILITY NUMBER:	191202451
ADMINISTRATOR:	KOHAR JARLEKIAN		FACILITY TYPE:	850
ADDRESS:	393 N LAKE AVE		TELEPHONE:	(626) 844-4755
CITY:	PASADENA	STATE: CA	ZIP CODE:	91101
CAPACITY:	181	CENSUS: 66	DATE:	07/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kohar Jarlekian		TIME COMPLETED:	12:25 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) Justin Dorsey conducted an unannounced Annual Random Inspection. LPA met with Kohar Jarlekian, Director, who guided LPA on a tour of the facility. The center is licensed as a preschool with an attached toddler option. The preschool/toddler programs do not have any shared areas. The facility also houses a private Kindergarten program which is exempt from a license. There are no shared areas among the private school and preschool/toddler programs. LPA inspected all areas identified on the Facility Sketch. The following staff were observed in each classroom during this visit: FL 103: No children present; HH 101: Staff #1, #2, #3 and #4 with 4 children; HH 106: Per director not in use for the summer; HH 107: Staff #5 and #6 with 6 children; HH 108: Staff #7 and #8 with 5 children; HH 109: Staff #9 and #10 with 3 children, during visit class was in room MS 101 playing in a jumper; OH 101: Staff #11 and #12 with 12 children; OH 102: Staff #13 and #14 with 6 children; OH 103: Staff #15 and #16 with 6 children; OH 104: Staff #17 and #18 with 6 children; OH 106: Staff #19 and #20 with 9 children (on playground during census); OH 105: Staff #21 and #22 with 9 children (on playground during census). Students have access to the classrooms, restrooms (located in the classrooms), courtyard (used during the afternoon) and outdoor play areas. Students of the program are signed in by their parents in their designated classroom. The facility does not provide transportation. Furniture and equipment are safe and in good repair. There is telephone service, heating, lighting and ventilation available at the facility. The main office and the restroom located in the staff lounge have been designated for the use of ill children Drinking water is available indoors and outdoors (children bring their own water bottles). Restrooms used were inspected for availability, good repair, toilet paper, area safety and sanitation.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

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: LAKE AVENUE CHURCH NURSERY SCHOOL, THE	FACILITY NUMBER: 191202451
	VISIT DATE: 07/12/2019

NARRATIVE

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The facility does not have a kitchen. The facility provides snacks and lunch is provided by parents. Containers used to discard food have tight fitting lid at this time. Snack menus were posted in each classroom. Snacks were reviewed for availability, quantity and appropriateness to children in care. Poisons are locked in a cabinet. Cleaning compounds and sharp items are inaccessible.

The outdoor areas include turf and padded areas with shade sails for shade. The play area is fully fenced. A review of records was conducted for staff and participants. LPA observed that staff have current First Aid and CPR (Expires 8/2020). Staff has met all immunization requirements. Ratios were observed to be in compliance. First Aid supplies are available. Disaster drills are documented and all posting requirements have been met.

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
REMINDER: Failure to obtain a criminal record background check clearance prior to initial presence will result in an immediate $100.00 dollar or more.

LPA advised how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. Also, discussed new requirements for providers, including mandate reporting training for staff which can be found at: http:/www.mandatedreporterca.com/training /training.htm. This is a new regulatory requirement beginning January 2018. According to staff, training has been completed through Community Care Licensing. Please review all elements outlined in AB 1207- Mandated Reporting Training.

No deficiencies were cited in accordance with California Code of Regulations Title 22. 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 reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director Kohar Jarlekian, Appeal Rights were given.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

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