191598274-9-22-2022-54-CC-MAYA-CJHQH3-20220922121029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191598274
Report Date: 09/22/2022
Date Signed: 09/22/2022 12:10:41 PM

Document Has Been Signed on 09/22/2022 12:10 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CALVERY CROSS CHAPEL PRESCHOOL		FACILITY NUMBER:	191598274
ADMINISTRATOR:	CLEMENTE, ROBIN		FACILITY TYPE:	840
ADDRESS:	16705 GRIDLEY ROAD		TELEPHONE:	(562) 924-3716
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90701
CAPACITY:	70	CENSUS: 0	DATE:	09/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Director, Robin Clemente		TIME COMPLETED:	12:30 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	On September 22, 2022 at 11:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Robin Clemente. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The facility is currently licensed for 70 school-age children, kindergarten age to 12 years. The facility is located on Calvery Cross Chapel premises. There is also a licensed preschool program on-site (License Number: 191502377). Per Director, the school-age program operates Monday through Friday from 6:30 am to 8:20 am, and 1:00 pm to 6:00 pm. The Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility has three (3) classrooms where care is provided. Upon arrival, there was one (1) staff (S1) and no children present. The following documents are posted in a prominent, publicly accessible area: Facility License, Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (LIC 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), and Daily Activity Schedule. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own locker to store their belongings. Per Director, the isolation area is in the office. In the office, a mat can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed in the classroom.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALVERY CROSS CHAPEL PRESCHOOL	FACILITY NUMBER: 191598274
	VISIT DATE: 09/22/2022

NARRATIVE

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The facility has smoke detectors and a carbon monoxide detector that were tested and are operable. The fire extinguishers are fully charged and were last serviced on April 20, 2022. The facility has verification of disaster and fire drills available for review. The last drill was conducted on June 15, 2022. First Aid supplies were observed and kept in the homework classroom.

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. All kitchen, food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste have tight-fitting covers that are kept on and in good repair.

The outdoor activity space is maintained in a safe condition and is free of hazards.There is no climbing apparatus. Balls, hula hoops, and other age appropriate recreational items are utilized. There is adequate shade in the outdoor play yard. Availability of outdoor drinking water was observed. No bodies of water were observed on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. 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 conducted a record review of five (5) children’s records and two (2) personnel records for completeness. Based on the record reviews, all children's records were complete as required by Title 22 regulations. Based on record reviews, 2 personnel (Director and S1) did not have a current Mandated Reporter Training Certificate available for review. All staff present have a current Pediatric First Aid and CPR certification. The names of children and staff whose records were reviewed were documented.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALVERY CROSS CHAPEL PRESCHOOL	FACILITY NUMBER: 191598274
	VISIT DATE: 09/22/2022

NARRATIVE

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Children's roster was reviewed and is current. Sign-in and sign-out sheets were reviewed. Per Director, transportation is provided by the facility for the school-age program. Staff who provide transportation have a current driver's license and required insurance. There are seat restraints available in the vehicles used for transportation. The facility provides the children with snacks. During the inspection, snacks were reviewed for availability and quantity. According to the Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in a cabinet located in the classroom. At this time, no children enrolled in care require any medication.

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.

LPA advised the Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

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.

Deficiency was cited during today's inspection (refer to deficiency page).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Robin Clemente. Appeal Rights were discussed, and a copy was provided to the Director.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/22/2022 12:10 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALVERY CROSS CHAPEL PRESCHOOL	FACILITY NUMBER: 191598274
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 staff records (Director and S1) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/24/2022
	Plan of Correction
1 2 3 4	Director will ensure that staff renew their Mandated Reporter training, and will submit proof of completion to LPA via e-mail by October 24th.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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