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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500590
Report Date: 03/05/2021
Date Signed: 03/05/2021 12:01:49 PM

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:ARCADIA EPISCOPAL PRESCHOOLFACILITY NUMBER:
191500590
ADMINISTRATOR:OSTROWSKI, MARIEFACILITY TYPE:
850
ADDRESS:1881 S. FIRST AVETELEPHONE:
(626) 445-5050
CITY:ARCADIASTATE: CAZIP CODE:
91006
CAPACITY:43CENSUS: 9DATE:
03/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marie Ostrowski - DirectorTIME COMPLETED:
12:10 PM
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Licensing Program Analysts (LPAs) Nolan Tcheng and Steven Rodriguez conducted an unannounced case management inspection due to an incident that occurred on 02/22/2021. LPAs arrived at 9:30AM and met with Director, Marie Ostrowski. Census was taken. There were 9 children present during the inspection.

The incident that occurred on 02/22/2021 was reported to the Department on 02/23/2021 via telephone. The facility did not become aware of the incident until the morning of 02/23/2021. The facility reported this incident to the Department within the required 24 hours.

On 02/23/2021, an unusual incident report was made to the department regarding an incident that occurred on 02/22/2021 which involved a child (Child #1) reportedly hitting another child (Child #2). The facility was made aware of the incident the next day and received photo of bruise on Child #2's chest from the parent after child disclosed he was hit. No staff or children observed the incident or were notified when it happened. LPAs observed the play area and apparatuses, pictures were taken. During inspection LPAs conducted interviews, however LPAs were unable to interview Child #2 due to being absent at time of inspection. DIrector states Child #2 usually arrives in the afternoon. Investigation will continue to conduct further interviews and/or obtain additional documentation. Due to insufficient information at this time, a follow up visit will be made later.

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director Marie Ostrowski.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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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