191231002-10-28-2021-33-CC-CGRN-C88RCM-20211028125433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191231002
Report Date: 10/28/2021
Date Signed: 10/28/2021 12:54:44 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:	CLEVELAND PRESCHOOL		FACILITY NUMBER:	191231002
ADMINISTRATOR:	PATRICIA GUZMAN		FACILITY TYPE:	850
ADDRESS:	524 PALISADE ST.RMB104		TELEPHONE:	(626) 794-7169
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	40	CENSUS: 33	DATE:	10/28/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Ree Hudson		TIME COMPLETED:	01:00 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) Crystal Green conducted an announced case management licensee initiated inspection to inspect and measure facility for capacity increase determination. Licensee is requesting to increase capacity by adding an additional classroom to their existing license. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Licensing staff met with Director, Ree Hudson, also present during the inspection was Program Specialist, Jeff Sankary. This facility operates on Cleveland Elementary school's campus and currently licensed to operate out of classrooms B-103 and B-104 that is not shared with the elementary school. At 10:35 AM, LPA was provided a tour of the facility’s existing licensed areas and the proposed additional classroom space. Per Director, facility is requesting to add one additional classroom to the facility’s licensed areas. The additional classroom called B-102 was observed to be located next to the preschool designated restroom. Licensing Staff also observe the classroom to have two entry doors. LPA observed one of the entry doors leads out to the Elementary school court yard. Per Director, the entry side door leading to the courtyard will be kept locked during operating hours. Report Continues Page 1 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

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 3

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: CLEVELAND PRESCHOOL	FACILITY NUMBER: 191231002
	VISIT DATE: 10/28/2021

NARRATIVE

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During this inspection, LPA observed 16 children in classroom B-103 with 3 staff members and 17 children in classroom B-104. The facility was observed to be operating within its licensed capacity. LPA inspected classroom B-102 and observed cots available along with age appropriate furniture. Individual storage space was available for each child located inside each classroom. Toys were observed to be clean and safe. There are smoke detectors and fire extinguishers located throughout the facility. The children were observed to have water accessible to them via water cooler with paper cups. LPA observed the water fountain located in each classroom attached to the sink to be made inaccessible to the children in care as a COVID precautionary methods.

Licensing staff was guided through the outdoor activity areas. This facility has 2 designated outdoor play areas. Outdoor play equipment was observed to be in good condition, free of sharp, lose or pointed parts. Outdoor equipment was observed to be age-appropriate. Outdoor activity space surface was observed to be maintained in a safe condition as is free of hazards. There is adequate shade available outdoors via canopies. LPA observed there to be cushioning material available in areas around and/or under climbing equipment to absorb a fall. LPA did not observe any violations or hazards outdoors.

Facility provides snacks and lunch for the enrolled children which is provided through the school district's food program that is brought in from an off-site location. 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 records were not reviewed during this inspection.

Report Continues Page 2 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CLEVELAND PRESCHOOL	FACILITY NUMBER: 191231002
	VISIT DATE: 10/28/2021

NARRATIVE

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As a COVID- 19 precautionary measure, Director states that parents drop off and pick up will be conducted inside of the main entry gated for preschoolers. Prior to accepting children, staff will conduct temperature checks and Covid-19 pre-screening questionnaire. Each classroom was observed to contain a temperature check station. As an additional precautionary measure, the facility was observed to have hand sanitizer stations located outside of each classroom.

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

At this time, the facility was observed to be operating in compliance with California Title 22 Regulations. Measurements were obtained during this inspection for the additional classroom. Based on measurements obtained today, the new capacity for the preschool program will be sixty (60) preschoolers. An approved Fire Clearance has been received by the department.

At 12:20pm, an exit interview was conducted with the Director, Ree Hudson. A copy of this report along with appeal rights and the Notice of Site Visit were provided to the Director.

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. End Report Page 3 of 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021

LIC809 (FAS) - (06/04)

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