191227188-1-28-2022-33-CC-NTCG-CB4QBA-20220128110113

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191227188
Report Date: 01/28/2022
Date Signed: 01/28/2022 11:01:22 AM

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:	MADISON PRESCHOOL		FACILITY NUMBER:	191227188
ADMINISTRATOR:	PATRICIA GUZMAN		FACILITY TYPE:	850
ADDRESS:	750 N. LOS ROBLES		TELEPHONE:	(626) 793-1181
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	22	CENSUS: 9	DATE:	01/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Cinthia Martinez - Lead Teacher		TIME COMPLETED:	11:15 AM

NARRATIVE

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Licensing Program Analysts (LPAs) Nolan Tcheng and David Kurdoglyan conducted an unannounced random annual inspection. Upon arrival at 8:30am, LPA met with Teacher Cinthia Martinez. At 8:45am, LPAs were led on a tour of the facility. This is a preschool program which consists of 1 classrooms. This facility is located on Madison Elementary School. Per supervisor, there are currently 18 enrolled in the program. This is a half day program with a morning and afternoon session. Hours of operation for this facility are 7:45-10:45am for Morning Session, and 11:45am-2:45pm for Afternoon Session, Monday-Friday.

Licensing staff observed all required forms/publications to be posted on the outdoor wall of the classroom by the entrance. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request.

PHYSICAL PLANT: At 8:45am, LPAs entered and inspected the classroom and observed 9 children with 2staff members. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects and rodents. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water was readily available indoors. Per Lead Teacher, nap time is not conducted due to program being half day sessions. At this time, the elementary school nurse's office is used as an isolation area. A cot is available for an ill child to rest on. First Aid supplies are available and complete above the sink in the classroom. Facility has a functioning carbon monoxide detector that meets statutory requirements. Director states there are no weapons, firearms, or bodies of water on the premises. At 8:55am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/03/2021 as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

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: MADISON PRESCHOOL	FACILITY NUMBER: 191227188
	VISIT DATE: 01/28/2022

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The facility restroom is attached to the classroom for the children in care. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly. Meals are provided from the elementary school cafeteria. This facility provides breakfast for the morning session and lunch for the afternoon session. Menu's are provided to parents online.

OUTDOORS: At 9:00am, LPAs reviewed the outdoor play area. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is one outside play space that is fenced. There are play structures for children to use and space for running activities. Drinking water is readily available outdoors.

FACILITY RECORDS: Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Staff files were unable to be reviewed at the time of inspection. Staff files are held at Cleveland Elementary School, where all licensed schools/facilities in the Pasadena Unified School District store their staff files. Lead Teacher provided their Pediatric CPR/First Aid that expires 03/2023. An inspection to review staff files at the Cleveland location will be conducted at a later date. A random sample of Children’s Records were reviewed to ensure that they are complete.

INCIDENTAL MEDICAL SERVICES:

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.

LPAs observed signs posted around classroom regarding COVID health and safety protocols. LPAs observed health screenings at the entrance of the classroom in the form of temperature checks and extra face masks.

REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

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: MADISON PRESCHOOL	FACILITY NUMBER: 191227188
	VISIT DATE: 01/28/2022

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LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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.

Exit interview was conducted with Lead Teacher Cinthia Martinez at 10:55am, including a copy of report.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022

LIC809 (FAS) - (06/04)

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