191291022-10-26-2022-33-CC-BBAT-CKKTXW-20221026150750

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191291022
Report Date: 10/26/2022
Date Signed: 10/26/2022 03:08:07 PM

Document Has Been Signed on 10/26/2022 03:08 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:	COTTAGE NURSERY SCHOOL		FACILITY NUMBER:	191291022
ADMINISTRATOR:	JOCELYN ROBERTSON		FACILITY TYPE:	850
ADDRESS:	169 WEST ARLINGTON DRIVE		TELEPHONE:	(626) 799-0387
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY:	40	CENSUS: 9	DATE:	10/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Teacher, Wallace Yovetich		TIME COMPLETED:	03:15 PM

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Licensing Program Analyst (LPA), Bardo Baluyot conducted an unannounced Required Annual site inspection. Upon arrival, LPA conducted a COVID risk self-assessment and met with Teacher, Wallace Yovetich who guided LPA on a tour of the facility. This is a preschool program which consists of 2 classrooms; RM Small Yard (2-3 years old), and RM Big Yard (3-5 years old). Facility operation hours are from Monday to Friday from 9:00 AM to 12:00 PM. Some older children stay for lunch time (lunch bunch) until 1:30 PM. This is Parent-Cooperative Program.

All areas identified on the Facility Sketch were inspected. LPA observed 2 children with 2 staff in the Small Yard and 7 children with 2 staff in the Big Yard. Children are signed in at the entrance to the building. All children present were observed to be signed in. Teacher child ratios were observed and staff names recorded.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Per Staff, there are no poisons on the premises. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing sinks are safe, sanitary and are operating properly. All floors are clean and safe. Storage area for poisons and other toxic chemicals observed to be locked.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Per staff, the facility no longer provides meals to children in care. All meal have been brought from home since the pandemic. Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors via children's personal water bottles. The facility was observed to be free of flies, other insects and rodents.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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: COTTAGE NURSERY SCHOOL	FACILITY NUMBER: 191291022
	VISIT DATE: 10/26/2022

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The facility does not transport children. Children do not nap in this program. The Director's office will be used by ill children. There is a napping cot and staff restroom available for an ill child.

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. The playground consists of hard landscape, cushioning, and soil yard areas. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Per Director, there are no bodies of water or firearms/weapons stored or allowed on the premises.

First Aid supplies were inventoried. A first aid kit is kept in each classroom. Carbon monoxide detectors and smoke detectors are present and in operable condition. Fire extinguishers showed it was last serviced on 10/10/22.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience, and health screening form for each staff present are on file and were reviewed.

In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

After a complete inspection of the facility, no deficiencies were observed/cited in accordance with California Code of Regulations Title 22 Division 12.

Exit interview conducted and report was reviewed with the Teacher, Wallace Yovetich.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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: COTTAGE NURSERY SCHOOL	FACILITY NUMBER: 191291022
	VISIT DATE: 10/26/2022

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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.

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

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.

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END OF REPORT

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

LIC809 (FAS) - (06/04)

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