191290371-5-12-2022-33-CC-NTCG-CECU77-20220512151928

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:19:38 PM

Document Has Been Signed on 05/12/2022 03:19 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:	JEFFERSON CHILDRENS CENTER		FACILITY NUMBER:	191290371
ADMINISTRATOR:	REE HUDSON		FACILITY TYPE:	850
ADDRESS:	391 NORTH SIERRA BONITA		TELEPHONE:	(626) 796-8845
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	70	CENSUS: 41	DATE:	05/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:38 PM
MET WITH:	Carolina Arizaga - Site Supervisor		TIME COMPLETED:	03:43 PM

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random annual inspection. Upon arrival at 1:38pm, LPA met with Site Supervisor Carolina Arizaga. At 1:45pm, LPA was led on a tour of the facility. This is a Preschool program which consists of 4 classrooms. This facility shares a campus with Jefferson Elementary School and is a part of the Pasadena Unified School District (PUSD). Per licensee, there are currently 45 enrolled in the program. Hours of operation for this facility are 7am-6pm, Monday to Friday.

Licensing staff observed all required forms/publications to be posted in the office. 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 1:45pm, LPA entered and inspected the classrooms during their nap time. Room 3: 15 children and 1 staff member, Room 4: 16 children and 3 staff members, Room 5: No children used that room today due to a school event (they shared classroom in Room 3), and Room 6 is currently not in use. Children were napping in each classroom on cots. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children in a locked cabinet. 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 in the form of water bottles provided from the facility. At this time, the 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 in each 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.

REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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: JEFFERSON CHILDRENS CENTER	FACILITY NUMBER: 191290371
	VISIT DATE: 05/12/2022

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At 2:15pm, A fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 09/24/2021, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. LPA observed restrooms in between Rooms 3 and 4, and Rooms 5 and 6. These restrooms are shared by classrooms on each side. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly. There is no kitchen on site. Per Site Supervisor, they have the food brought to this facility from the nearby high school that is a part of the PUSD. This facility provides breakfast, lunch, and pm snack.

At 2:25pm, LPA 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 includes a sand area with play houses and a play structure, swings, a bike path, a grass area, and an area with toys and equipment for children to play with. Another outside space observed was a garden area. Per Site Supervisor, the children in care conduct gardening activities with their teachers. Drinking water is readily available outdoors.

Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher during tour. The Licensee is within the conditions, limitations, and capacity specified on the license. All areas were identified on the Facility Sketch were inspected.

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 the Human Resources office for PUSD, 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 05/2024. An inspection to review staff files at the Human Resources office will be conducted at a later date. A random sample of Children’s Records were reviewed to ensure that they are complete.

LPA observed COVID-19 Health and Safety protocols being conducted at the facility. LPA discussed with facility what the Los Angeles County Guidance currently is.

REPORT CONTINUE PAGE 2 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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: JEFFERSON CHILDRENS CENTER	FACILITY NUMBER: 191290371
	VISIT DATE: 05/12/2022

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INCIDENTAL MEDICAL SERVICES:
This facility provides Incidental Medical Services –( IMS). Facility has submitted IMS plan for all locations. 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

Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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/process

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 Kerem Martinez-Campos, at 3:25pm. Copy of report was provided

END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC809 (FAS) - (06/04)

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