191231002-4-10-2023-33-CC-CGRN-CQRQYN-20230410123526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191231002
Report Date: 04/10/2023
Date Signed: 04/10/2023 12:35:32 PM

Document Has Been Signed on 04/10/2023 12:35 PM - It Cannot Be Edited

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:	REE HUDSON		FACILITY TYPE:	850
ADDRESS:	524 PALISADE ST.RMB104		TELEPHONE:	(626) 396-5762
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	60	CENSUS: 40	DATE:	04/10/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:00 AM
MET WITH:	Lindsey Lewis		TIME COMPLETED:	12:55 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 unannounced case management licensee- initiated inspection to inspect and measure facility for capacity increase determination. LPA met with Site Director, Lindsey Lewis, who provided analyst a tour of the facility. Facility operation hours are from Monday to Friday from 7:00 AM to 6:00 PM. This facility currently operates on Cleveland Elementary school's campus. The facility shares the premises with Alma Fuerte Charter School. The preschool program currently operates out of classrooms B102, B103 and B104 that is not shared with the charter school. The preschool was observed operating and census was obtained during this inspection. The facility was observed to be operating within its licensed capacity. Licensee has requested to increase their capacity by adding (3) additional classroom to their existing license. The proposed additional classrooms will be classroom 142 located within the main building next to the main office. Classroom B101 and B100 which is located next to the existing licensed classrooms. LPA observed classroom 142 to have a restroom accessible to the children locate within the classroom. Classroom B101 and B100 will have access to the restroom located in the courtyard. All toilets and handwashing facilities are in safe and sanitary operating conditions. Per Director, children will be escorted to and from the restroom at all times. LPA inspected the proposed additional classrooms and observed age-appropriate furniture. Individual storage space was available for each child located inside the classroom. Toys were observed to be clean and safe. There are smoke detectors and fire extinguishers located throughout the facility. There will be drinking water accessible to the children in care via water fountain attached to the sink located in each classroom and personal sippy cups.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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: CLEVELAND PRESCHOOL	FACILITY NUMBER: 191231002
	VISIT DATE: 04/10/2023

NARRATIVE

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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 in the outdoor play area. 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.

An approved Fire Clearance has been received by the department. Upon return to the regional office, a final review of the application documents will be completed prior to approval for capacity increase to (120) preschoolers.

Exit interview conducted and report was reviewed with Site Director. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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