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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494283
Report Date: 08/14/2019
Date Signed: 08/14/2019 04:09:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PEAK PROGRAMS - WILBUR CHARTER SCHOOLFACILITY NUMBER:
197494283
ADMINISTRATOR:BARTHOLOMEW, SCOTTFACILITY TYPE:
850
ADDRESS:5213 CREBS AVETELEPHONE:
(818) 345-1090
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:110CENSUS: 0DATE:
08/14/2019
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Scott BartholomewTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA’s) Antonio Almanza, Marastella Gutierrez and Licensing Program Manager (LPM) Victor Bautista conducted an in-office meeting August 14, 2019 met with Applicant, Scott Bartholomew, President along with Angela Parretta of Peak Programs INC. The purpose of today’s meeting is to review the application for a school-age program located on LAUSD school site, capacity of 110 children ages 5-12.

A full review of the submitted application was discussed which included: Section A and B (Parent handbook and Plan of operation) forms.
Items discussed and requiring re-submission:
Adumbrative Organization form LIC 309, LIC 200A (Childcare Application form), LIC 610 (Emergency Disaster Plan), LIC 999 (Facility Sketch).

Items that we received today are Control Of Property (Lease Agreement), Fire Clearance was approved on and received on July 26, 2019 for 110 Children.
Part of today’s discussion included necessary updates:
Personnel Procedures: In service Training and Mandated reporting requirements (AB1207)
Also, in discussion relating to the Parent Handbook and Admission Agreement: Which included clarification of terminology, Removal of exerts not applicable, updating of language which will make the plan of operation compliant with title 22 regulations and Heath and Safety Code.

Due to extensive nature of the feedback provided to the applicant the LIC 184 (Notice of Incomplete Application) will be forwarded via mail to the Applicant address on record.
Pre-licensing scheduled for August 15, 2019.
An exit interview is being conducted, a copy of this report is being reviewed and furnished to the Applicant.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Stella GutierrezTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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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