191597492-5-9-2023-33-CC-JMOA-CRNUFL-20230509153256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191597492
Report Date: 05/09/2023
Date Signed: 05/09/2023 03:33:12 PM

Document Has Been Signed on 05/09/2023 03:33 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:	WASHINGTON/CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	191597492
ADMINISTRATOR:	KYM ALLEN		FACILITY TYPE:	850
ADDRESS:	975 E. NINTH AVE		TELEPHONE:	(909) 620-4266
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	60	CENSUS: 13	DATE:	05/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Kym Allen		TIME COMPLETED:	03:45 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 Analyst (LPA) Judy Mora conducted an unannounced Required 1 year inspection. LPA met with Kym Allen, Child Development Facilities Licensing Planner. This is a preschool program serving 60 children ages 2 to entry into kindergarten. The facility operates Monday – Friday from 7:30 AM – 3:30 PM. Per staff there are 45 children enrolled. There are three classrooms at this location, two classrooms are currently being utilized. All areas identified on the facility sketch were inspected. LPA observed 13 children with 02 staff from Room C104, there were no other children present in the other classrooms. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. During this inspection, all children were observed to be under visual supervision of a teacher at all times. Criminal Record clearances were not reviewed as it is a condition of employment with Pomona Unified School District. LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, Snack Menus, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed, last drill was May 2023. 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 surfaces and materials accessible to children, including toys, are toxic free. All toilets are in safe and sanitary operating conditions. All classroom floors were observed to be safe and clean. REPORT CONTINUES ON NEXT PAGE*

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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: WASHINGTON/CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191597492
	VISIT DATE: 05/09/2023

NARRATIVE

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At this time, the quiet areas in each classroom are used as an isolation area. Children will use the staff restroom if needed. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides breakfast, lunch and PM snack. All food is provided by the elementary school cafeteria. LPA observed jugs of water and disposable cups available for drinking water. All containers used for storage of solid wastes have a tight fitting cover on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

The outdoor playground is fully fenced. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed age appropriate toys and equipment. The areas around and under high climbing equipment, slings or slides have cushioning that absorbs a fall. Outdoor activity space surface is maintained in a safe condition as is free of hazards. A sufficient shaded area was observed. The Program Manager states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Staff states there are no weapons or firearms on the premises.

Transportation services are not provided at this facility. Children's sign in and out sheets were reviewed. LPA observed all children present to be signed in.

Staff Records were reviewed to ensure the following are present: Staff qualifications, proof of immunization’s, 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’s Rights. Staff files were observed to be complete.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: WASHINGTON/CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191597492
	VISIT DATE: 05/09/2023

NARRATIVE

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

This facility provides Incidental Medical Services – IMS. IMS are provided at the facility. Storage of medications and medications were reviewed. 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.

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.

There were no deficiencies given during this inspection.

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.

Exit interview conducted and report was reviewed with Kym Allen, Child Development Facilities Licensing Planner.

*End of report

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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