197414773-8-16-2019-54-CC-RRAS-BF4Q5F-20190816115153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414773
Report Date: 08/16/2019
Date Signed: 08/16/2019 11:51:58 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CORONA ELEMENTARY SCHOOL PKFLP		FACILITY NUMBER:	197414773
ADMINISTRATOR:	RACHEL SALDANA		FACILITY TYPE:	850
ADDRESS:	3825 BELL AVENUE RM. 13		TELEPHONE:	(323) 560-1323
CITY:	BELL	STATE: CA	ZIP CODE:	90201
CAPACITY:	22	CENSUS: 0	DATE:	08/16/2019
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Rachel Saldana, Principal		TIME COMPLETED:	12:10 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 Analysts (LPAs) Rita Ramos and Alicia Mooberry conducted an announced case management inspection to the above facility. LPAs met with Rachel Saldana, Principal, and Alejandra Vasquez, Teacher, who provided a tour of the facility. There were no children present during the inspection. The purpose of the visit was to follow-up on a case management inspection that was conducted on 08/06/19 to ensure that all items that were requested have been submitted and corrected prior to granting a temporary relocation license. The Licensee has requested a temporary room relocation due to construction occurring at the elementary school. The facility is currently licensed in Room 13 and has requested a temporary relocation to Room 61. The expected date for the construction to end is in January of 2020. During the 08/06/19 inspection, LPAs were not able to inspect Room 61 due to it not being set-up, therefore, not conducive for children's use. In addition, LPAs did not inspect the cafeteria during the 08/06/19 inspection. While touring the cafeteria, LPAs observed that the kitchen area/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Per Teacher, the children's meals are prepared and stored in the cafeteria/kitchen and are then delivered in a cart to the classroom. Upon entering Room 61 LPAs observed that the classroom was set-up. LPAs took additional measurements for the deduction of encumbered space and observed that the classroom did not have a carbon monoxide detector. The Principal and the Teacher purchased and placed a functioning carbon monoxide detector during the inspection. -----Page 1 of 3

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

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: CORONA ELEMENTARY SCHOOL PKFLP	FACILITY NUMBER: 197414773
	VISIT DATE: 08/16/2019

NARRATIVE

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13. A copy of the Daily Schedule was provided during the inspection.

The following items are still pending prior to granting the license for a room relocation:

- An updated LIC 501 Personnel Summary from the Principal
- A copy of the Step II Orientation from the Principal
- An LIC 508 Criminal Record Statement from the Principal

Based on the measurements taken today:

Room 61 has space for 34 preschool children, however, the fire clearance that was granted is for 22 and the capacity requested is for 22, therefore, after receiving the aforementioned and a final review of the application packet, the facility may be licensed for 22 in Room 61.

There were no deficiencies cited during today’s inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Rachel Saldana, Principal, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

Page: 3 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CORONA ELEMENTARY SCHOOL PKFLP	FACILITY NUMBER: 197414773
	VISIT DATE: 08/16/2019

NARRATIVE

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During today's inspection (08/16/19), LPAs observed that the following has been submitted and/or corrected:

1. The sink in Room 61 functions for the purpose of hand-washing, however, the facility has purchased cases of water bottles as drinking water to provide to the preschool children.

2. All required forms to be posted were observed to be posted.

3. First-Aid kit was available and had the required items.

4. Room 61 was set-up and it is now conducive for children's use.

5. An updated waiver that reflects the new distance from Room 61 to the outdoor yard was provided.

6. A facility sketch that reflects the building and location of the restrooms along with the amount of sinks, toilets,
and urinals available for preschool children's use was provided. A sketch to reflect where Room 61 is located
and the distance and buildings that children need to walk by to get to the outdoor yard was also provided.

7. A restroom sign indicating that preschool children can also utilize the restrooms was posted.

8. The LIC 200A: Application for a Child Care Center was updated and corrected during the inspection.

9. LIC 9108 Statement Acknowledging the Requirement to Report Child Abuse for the Principal was provided.

10. Pediatric CPR/First Aid card for the Teacher was provided and it expires on 06/16/20.

11. The LIC 500 Personnel Report was provided during the inspection.

12. The LIC 610 Emergency Disaster Plan was provided during the inspection.
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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita Ramos	TELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019

LIC809 (FAS) - (06/04)

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