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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191231000
Report Date: 01/08/2020
Date Signed: 01/08/2020 10:40:07 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:WILLARD PRESCHOOLFACILITY NUMBER:
191231000
ADMINISTRATOR:PATRICIA GUZMANFACILITY TYPE:
850
ADDRESS:301 S. MADRE ST.TELEPHONE:
(626) 796-9877
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:24CENSUS: 18DATE:
01/08/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Alis VanegasTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ariel Cazares conducted an unannounced annual/random inspection on this date. LPA met with Teacher Alis Vanegas and was guided on a tour of the facility. There were 18 children present with 3 staff total. The facility is located on the campus of Willard Elementary School in Classroom #401 that faces Madre St.

LPA inspected the facility indoors and outdoors. The facility consists of 1 classroom and a separate outdoor playground. 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. Children do not nap in this program. There is available drinking water in form of a water fountain attached to a children's sink. There are first aid kit located above the adult sink. LPA tested the carbon monoxide detector located at the entrance of the classroom and found it to be operational. The children’s restroom is located in the classroom and was observed to be clean and sufficient supplies available. Sinks and toilets were functioning.

Children are provided a hot lunch by the school. A staff obtains the lunch from the school cafeteria and delivers the lunch to the classroom. LPA observed required postings on a parent board at the entrance of the facility. LPA did not observe a lunch menu posted. Per Teacher Alis, the school has not provided the menu yet.

Per teacher, the school nurse's office is used as the isolation area for ill children. Medication brought for children is stored in nurse's office. Per Teacher Alis, there are no children currently enrolled with medication needs.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLARD PRESCHOOL
FACILITY NUMBER: 191231000
VISIT DATE: 01/08/2020
NARRATIVE
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LPA inspected the children’s outdoor space. The playground was inspected for safety, cushioning material, good repair and age appropriateness. LPA observed there to be shade and adequate fencing. The playground was observed to be clean and free of debris or loose trash. Drinking water is available in form of water fountains. LPA tested the fountains and found that the water pressure is low not providing water flow so that children can drink water without placing their mouth on the spout. An alternative form of outdoor drinking water is not available for children.

Teacher child ratios were observed to be in compliance. Care and supervision was evaluated to determine if the basic needs of children are met.

Children's files were reviewed and observed to be complete. Sign in and out sheets were reviewed. LPA observed that Child #1 & #2 present today were signed not signed in. Per teacher, the children were signed in on the wrong date. Staff files were not reviewed as they are maintained at the main office.

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 809-D attached for deficiencies cited. Exit interview conducted with Teacher Alis Vanegas. A copy of this report and appeal rights were provided and explained.

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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2020
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLARD PRESCHOOL
FACILITY NUMBER: 191231000
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2020
Section Cited

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The person who brings the child to, and removes the child from, the center shall sign the child in/out.
This requirement has not been met as evidenced by LPAs review of sign in/out sheets. LPA observed that Child #1 & #2 present on this date were not signed in on this date.
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This poses a potential risk to the health and safety of children in care.
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Type B
01/15/2020
Section Cited

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Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

This requirement has not been met as evidenced by LPAs observation of the outdoor water fountains not providing water flow that would prevent children
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from placing their mouths on the spout.
This poses a potential risk to the health and safety of children in care.
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2020
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WILLARD PRESCHOOL
FACILITY NUMBER: 191231000
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2020
Section Cited

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Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative.
This requirement has not been met as evidenced by LPA's observation that a lunch menu was not posted. This poses a potential risk to health and safety of children in care.

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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4