191290432-5-20-2022-33-CC-MMEO-CELTSK-20220520145916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290432
Report Date: 05/20/2022
Date Signed: 05/20/2022 03:01:22 PM

Document Has Been Signed on 05/20/2022 03:01 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:	WILLARD CHILDREN'S CENTER		FACILITY NUMBER:	191290432
ADMINISTRATOR:	REE HUDSON		FACILITY TYPE:	850
ADDRESS:	345 SO. HALSTEAD ST.		TELEPHONE:	(626) 792-5763
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	64	CENSUS: 34	DATE:	05/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Yanira Munoz - Lead Teacher		TIME COMPLETED:	11:48 AM

NARRATIVE

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random annual inspection. Upon arrival at 8:40am, LPA met with Lead Teacher Yanira Munoz. At 8:50am, LPA was led on a tour of the facility. Site Supervisor Lorna Washington arrived at 9:30am. This is a Preschool program which consists of 3 classrooms. This facility is adjacent to the campus of Wilson Middle School (currently closed) and is a part of the Pasadena Unified School District (PUSD). Per licensee, there are currently 40 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 8:50am, LPA entered and inspected Room 1: 18 children with 2 staff members, Room 2: Not currently being used due to enrollment, and Room 3: 16 children with 4 staff members. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. 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. At this time, Room 2 is used as an isolation area. A cot is available for an ill child to rest on. First Aid supplies are available and complete. 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. At 8:57am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 12/08/2021 as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. 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: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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: WILLARD CHILDREN'S CENTER	FACILITY NUMBER: 191290432
	VISIT DATE: 05/20/2022

NARRATIVE

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Each classroom has its own restrooms attached for the children in care to use. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly. The facility has their food cooked and prepped at Wilson Middle School's kitchen and is brought to the facilities kitchen. The facility kitchen is used only as a food preparation area. All food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Snacks were reviewed for availability, quantity and appropriateness to children in care. This facility provides breakfast, lunch, and pm snack. LPA reviewed the storage of napping equipment. Napping equipment was observed to be cots.

At 9:10am, 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 is strictly hard-top and has a bike path. Another outside play space observed has a sand area for play with a swing set, a play structure, another bike path, and age appropriate toys and equipment. 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 11/2023. 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. At 10am, during children's file review, LPA observed that 3 of 5 children files did not have an LIC503 Health Screening Report present. LPA discussed the importance of having this form completed upon enrollment for all children.

LPA observed COVID Health and Safety protocols being followed at the facility. Staff and children were wearing face masks, temperature checks were being conducted at drop off, and social distancing was being upheld in the classrooms. REPORT CONTINUES 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: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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: WILLARD CHILDREN'S CENTER	FACILITY NUMBER: 191290432
	VISIT DATE: 05/20/2022

NARRATIVE

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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/

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

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 Site Supervisor Lorna Washington, at 11:20am, and Plan of Corrections were reviewed and developed. 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: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 05/20/2022 03:01 PM - It Cannot Be Edited

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 CHILDREN'S CENTER	FACILITY NUMBER: 191290432
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 5 children files, Child #1, 3, & 4, did not have an LIC503 Health Screening Report, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/20/2022
	Plan of Correction
1 2 3 4	Per Site Supervisor, parents will have the form filled out with the physician. Supervisor plans to do review of all children files and to discuss with PUSD employee that handles enrollment to ensure the LIC503 is complete and present before child start date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC809 (FAS) - (06/04)

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