191597974-1-9-2020-33-CC-JHUA-BKNRMA-20200109120824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191597974
Report Date: 01/09/2020
Date Signed: 01/09/2020 12:08:29 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:	UNITED MOLOKAN CHRISTIAN ASSOC.PRESCHOOL		FACILITY NUMBER:	191597974
ADMINISTRATOR:	STEPHANIE PIVOVAROFF		FACILITY TYPE:	850
ADDRESS:	16222 E. SORIANO DRIVE		TELEPHONE:	(626) 336-5958
CITY:	HACIENDA HEIGHTS	STATE: CA	ZIP CODE:	91745
CAPACITY:	25	CENSUS: 15	DATE:	01/09/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Stephanie Pivovarof		TIME COMPLETED:	12:15 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	Random inspection was conducted today by Licensing Program Analyst, Jennifer Hua. LPA met with director, Stephanie Pivovarof. LPA toured the facility for a children's health and safety inspection. Child care areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Napping equipment and bedding were inspected for good condition, appropriate storage and cleanliness. Storage for children's belongings and an isolation area with sink, toilet, and mat/cot were inspected. Facility operates Tuesday-Thursday 8am-2:45pm. There is also a private elementary program on site grades K-6th. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. A review of medication policy, including administering, labeling, storage, and records were discussed. Medication is not administered per director. Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Cleaning and food supply storage areas were also observed. Outdoor equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

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: UNITED MOLOKAN CHRISTIAN ASSOC.PRESCHOOL	FACILITY NUMBER: 191597974
	VISIT DATE: 01/09/2020

NARRATIVE

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Teacher child ratios were observed and staff names recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate. Staff was questioned to establish their familiarity of reporting requirements, emergency disaster plans and other site operations. All staff have completed the Mandated Reporter Training as required.

Sign in and out sheets were reviewed Personal Rights of children were discussed and observed by LPA.

A review of children’s & Staff records were reviewed to identify that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Verification of Pediatric CPR/First Aid and Preventative Health Practices were made.

Incidental Medical Services - (IMS) was discussed. For IMS information see Evaluator Manual - Regulation and Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

No deficiency cited.
Notice of Site visit form was provided and explained. The notice must be posted for 30 days in an area accessible for review. a $100 civil penalty will be assessed if removed prior to the 30 days.
For updates, forms, Title 22 Regulations, visit department website: www.ccld.ca.gov
Exit interview was conducted with director. Copy of report given.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Jennifer Hua	TELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020

LIC809 (FAS) - (06/04)

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