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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191504181
Report Date: 06/15/2022
Date Signed: 06/15/2022 05:11:53 PM


Document Has Been Signed on 06/15/2022 05:11 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:LA VERNE PARENT PARTICIPATION PRESCHOOLFACILITY NUMBER:
191504181
ADMINISTRATOR:ELIZABETH TOMASHEFSKYFACILITY TYPE:
850
ADDRESS:909 EAST JUANITA AVE.TELEPHONE:
(909) 599-9857
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:34CENSUS: 16DATE:
06/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Director Elizabeth TomashefskyTIME COMPLETED:
05:30 PM
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On this date, Licensing Program Analyst (LPA) Emiko Bell conducted an unannounced Required-5 year inspection. Upon LPA's arrival at the Preschool office, LPA Bell was greeted by Director Elizabeth Tomashefsky, to whom the purpose of the inspection was announced.

At 10;00 am, Director Tomashefsky guided LPA on a tour of both classrooms, the playground and the separate restroom used by the chidren.

Census: in both the Sunflower and the Lavender room, there was one staff and two parent volunteers with 8 children each. Staff-child ratio was met. Both staff are cleared and associated.

Throughout the entire inspection, LPA and staff wore face coverings as a precautionary measure against COVID-19. The COVID screening questions were posed to Director Tomashefsky and all were responded to with "No."

This is a preschool age program licensed for 34 children which operates Monday – Friday from 09:00 am- noon.

LPA observed required forms (LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights) to be posted in the window of each classroom, the license is posted in the office, and the Emergency Disaster Plan is posted in each classroom and in the office There is no snack menu because parents provide the snack. Verification of Disaster and
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2022
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: LA VERNE PARENT PARTICIPATION PRESCHOOL
FACILITY NUMBER: 191504181
VISIT DATE: 06/15/2022
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Fire Drills were reviewed.

LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair; free of sharp, loose, or pointed parts. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, the Daisy Room is used as an isolation area. Parents are contacted immediately when children are determined to be ill. At drop off, between 09:00-09:15 am, children's temperature is checked by the teacher and the parents are completing a three question COVID-related questionnaire on the Brightwheel app. Parents cannot sign on the app without completing the health questionnaire.

During this time, children being in their own water bottles. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning fire extinguishers, smoke and carbon monoxide detectors that meet statutory requirements.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. There are Tuff tray tables which hold water which were observed on the Lavender side today; adult supervision is required when a child is playing with the water. Director states there are no weapons or firearms on the premises.

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.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
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: LA VERNE PARENT PARTICIPATION PRESCHOOL
FACILITY NUMBER: 191504181
VISIT DATE: 06/15/2022
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From 01:13-03:33 pm, LPA reviewed both staff and children's files. Staff records were reviewed to ensure the following are present: qualifications, proof of immunizations, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee Rights.

Children’s Records were reviewed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 9224 Acknowledgement of Receipt of Licensing Reports, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parents' Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

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.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
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: LA VERNE PARENT PARTICIPATION PRESCHOOL
FACILITY NUMBER: 191504181
VISIT DATE: 06/15/2022
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The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.

Director 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.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.



There were no deficiencies issued during this inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Elizabeth Tomashefsky.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC809 (FAS) - (06/04)
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