192002562-11-4-2020-33-CC-ACAS-BV2QLP-20201104111617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192002562
Report Date: 11/04/2020
Date Signed: 11/04/2020 11:17:56 AM

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:	ANGELINA PRESCHOOL		FACILITY NUMBER:	192002562
ADMINISTRATOR:	PEREZ, ADRIANA		FACILITY TYPE:	850
ADDRESS:	1336 ANGELINA STREET #108		TELEPHONE:	(213) 481-0227
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90026
CAPACITY:	73	CENSUS: 26	DATE:	11/04/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nicole Lopez		TIME COMPLETED:	11:00 AM

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 11/4/2020, Licensing Program Analyst (LPA) Ariel Cazares met with Director Nicole Lopez of the licensed facility via FaceTime. The purpose of the visit was to provide technical assistance to the facility that has been granted a waiver to temporarily use an unlicensed room as a classroom for the preschool children. The facility did not increase their capacity. This waiver will be used to due to the spread of COVID-19 in Southern/Northern California. The child care will be operated Monday through Friday, 7am to 5pm and under the waiver , with a combined total capacity of 24 under the waiver. Should the facility need to increase capacity beyond what has been approved in the waiver or any changes to the conditions of the waiver occur, Angelina Preschool shall notify the Monterey Park Child Care Regional Office. At 10:30am, Director Nicole Lopez guided LPA tour of the facility. LPA viewed all preschool rooms currently in use: P1, P2, & P3. There were a total of 3 groups each with 2 staff. A total of 26 preschool childern were present. LPA viewed the proposed room, P4 (previously known as gym/workout room, that will be used under the waiver.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel Cazares	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

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: ANGELINA PRESCHOOL	FACILITY NUMBER: 192002562
	VISIT DATE: 11/04/2020

NARRATIVE

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There was age appropriate equipment and desks distanced apart. If child/ren become ill during the course of the day, they will be placed in the isolation area in the office. Drinking water is available via personal water bottles or water jug and disposable cups.

At 10:33 LPA was guided through the outdoor space designated which is divided into two via a gate. Children go out with their cohort and the space is disinfected and cleaned in between each group. Drinking water is available in form of personal water bottles and a water station is available outdoors. Children practice social distancing outdoors.

At 10:40 LPA was shown the entrance of the facility where children are checked in and out. Temperatures are taken and logged. There are postings of information and COVID-19 related materials. Hand sanitizer is also made available.

To further ensure health and safety of the children in care, Community Care Licensing will provide on-going Technical Assistance (TA) to Angelina Preschool. LPA advised director to stay updated with the Provider Information Notices (PINs) on the department website www.ccld.ca.gov as well as www.covid19.ca.gov for COVID-19 related information.

An exit interview was conducted with Director Nicole Lopez. A copy of this report will be sent via email with an attached read receipt as proof of receipt. LPA request report be signed and a copy returned to the Regional Office.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel Cazares	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020

LIC809 (FAS) - (06/04)

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