191500590-3-12-2021-33-CC-NTCG-BZ2VG5-20210312152458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191500590
Report Date: 03/12/2021
Date Signed: 03/12/2021 03:25:06 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 PRESCHOOL		FACILITY NUMBER:	191500590
ADMINISTRATOR:	OSTROWSKI, MARIE		FACILITY TYPE:	850
ADDRESS:	1881 S. FIRST AVE		TELEPHONE:	(626) 445-5050
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91006
CAPACITY:	43	CENSUS: 11	DATE:	03/12/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Marie Ostrowski - Director		TIME COMPLETED:	03:40 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 Analysts (LPAs) Nolan Tcheng and Steven Rodriguez conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 02/23/2021. Upon arrival, LPAs met with Director Marie Ostrowski at 2:30PM, who provided LPA a tour of the facility inside and outside. Following COVID-19 health and safety protocols, LPAs wore facemasks during the entirety of the inspection. Census was taken. There were 11 children present at the time of inspection. On 02/23/2021, an incident was reported to the department where a parent contacted the Director stating Child #1 hit Child #2. The facility received photo from the parent of Child #2, showing bruise on chest area. Per interviews with children and staff, no staff or children observed the reported incident and staff stated they were not notified by children involved when the incident occurred. The facility reported the incident to the Department within the required 24 hrs. LPA observed the outdoor play area and inquired with Director about the climbing apparatus. Director states apparatus has been at the facility since 2008 and that there have not been any injuries from the structure before. Child #2 was not present during the time of inspection and LPAs were unable to conduct interview. During course of inspection there was not enough evidence to indicate that the bruise on Child #2's chest was or was not caused by Child #1 while in the supervision of facility staff. Based on observation, the documents obtained during the investigation and the interviews conducted with staff and children, there was not enough evidence to determine that there was violation of Title 22 regulations. LPA Tcheng is issuing an Advisory Note (LIC9102) to the facility to provide advisement of increased supervision of Child #1 during play time with other children and increased supervision of children when playing on climbing apparatus. LIC9102 was provided to the Director at time of inspection. REPORT CONTINUES ON PAGE 1 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

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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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: ARCADIA EPISCOPAL PRESCHOOL	FACILITY NUMBER: 191500590
	VISIT DATE: 03/12/2021

NARRATIVE

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Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

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 conducted with the Director Marie Ostrowski at 3:25PM. A printed copy of this report and appeal rights (LIC 9058) were provided at the conclusion of the visit and the signature on this form acknowledges receipt of these forms.

END OF REPORT 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021

LIC809 (FAS) - (06/04)

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