191231002-4-10-2023-33-CC-CGRN-CQRQY8-20230410123444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191231002
Report Date: 04/10/2023
Date Signed: 04/10/2023 12:34:53 PM

Document Has Been Signed on 04/10/2023 12:34 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:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Lindsey Lewis		TIME COMPLETED:	12:00 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 unannounced required 1 year inspection. Licensing Staff met with Site Director, Lindsey Lewis. 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. There is another program operating on this school campus named 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 following was observed during this visit. At 10:42 AM, Licensing staff observed 16 children with 3 staff members in classroom B104. Licensing staff observed 12 children with 3 staff in classroom B103. In classroom B102, Licensing staff observed 12 children with 4 staff members. Teacher-child ratios were observed. All children were observed by licensing staff to be under visual supervision of a teacher at all times. Licensing staff observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. There is drinking water accessible to the children in care via water fountain attached to the sink in each classroom and personal sippy cups. At this time, the Director’s office is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted. Children are signed in by parents upon entry to their designated classroom. Report Continues Page 1 of 2

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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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. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment, swings and slides have cushioning material to absorb a fall.

Staff Records were not reviewed during this inspection. Staff files are maintained at the licensee HR main office located in Burbank, CA. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file.

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

At this time, the licensee is in compliance with California Title 22 Regulations. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Exit interview was conducted with Site Director, Lindsey Lewis.A notice of site visit was given and must remain posted for 30 days. Report Ends Page 2 of 2

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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