197494283-8-15-2019-30-CC-AALA-BF3RQS-20190815131400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494283
Report Date: 08/15/2019
Date Signed: 08/15/2019 01:14:15 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 SCHOOL		FACILITY NUMBER:	197494283
ADMINISTRATOR:	BARTHOLOMEW, SCOTT		FACILITY TYPE:	850
ADDRESS:	5213 CREBS AVE		TELEPHONE:	(818) 345-1090
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	110	CENSUS: 0	DATE:	08/15/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Scott Bartholomew		TIME COMPLETED:	01:10 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	On 08/15/19 LPA’s Antonio Almanza, Marastella Gutierrez and LPM Victor Bautista conducted a pre-licensing visit. LPA’s and LPM met with applicant Scott Bartholomew whom guided the tour of the facility. The site visit was conducted on an approved LAUSD (Los Angeles Unified School District) Site, Wilbur Avenue School. Upon arrival the School site was entered through the main entrance in the corner of Wilbur and Crebs. The applicant is applying for a capacity of 110 school-aged children, ages 5 to 12, the facility will operate a morning (AM) and after school (PM) program, utilizing The Beth Taylor Library, Room 7, and the Parent Center located near the Administration building. Outdoor space in the main play yard and adjacent to the parent center will be used for facility activities. The AM program will be conducted in the Parent Center which is located behind the Beth Taylor library. All children will be in the parent center from 7-8am. The parent center has one entrance in the front and an emergency exit in the back-center window. A fire extinguisher was observed in the right-hand side of the entrance to the parent center. A carbon monoxide detector was observed on the left wall of the room. There is a functioning sink and water faucet in the right back corner of the room. Storage are for kids’ belongings is along the back wall. per applicant Scott Bartholomew, during AM activities there will be no more than 30 children participating and supervised at the Parent Center. During PM hours of operation children will be in the Parent Center, Beth Taylor Library, and Room#7. The Parent Center will have Kindergarten children. During Pm hours Children will use the play area adjacent and behind stand alone building. The Beth Taylor Library is adjacent to the main office on the pathway from the main entrance. It has one entrance in the right-hand side and an exit in the left back corner. The Library has a working phone in the left back corner behind the librarian’s desk. There will be Cubies or space for children to store there belonging along the back wall next to the librarian’s desk. The library book will not be used for pm activities. During pm hours the library will be used for grade levels 2-5. (Cont'd Pg2)

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEAK PROGRAMS - WILBUR CHARTER SCHOOL	FACILITY NUMBER: 197494283
	VISIT DATE: 08/15/2019

NARRATIVE

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Cont'd From Pg2.
The following items will be required form the Applicant:
- Procedures for contacting 911
- Refrigerator in parent cent cleaned out
- Picture of Cabinet for records
- When will parent center Phone Land Line will be activated
- Method for communication between classrooms
Time frame for corrections have been discussed with applicant. Applicant indicates he will have corrections submitted to CCL office by 08/19/19 12:00 pm .
An exit interview was conducted, and a copy of the report was review and furnished to the applicant.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEAK PROGRAMS - WILBUR CHARTER SCHOOL	FACILITY NUMBER: 197494283
	VISIT DATE: 08/15/2019

NARRATIVE

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There will be approximately 30-39 children in the library. Peak Programs will provide all equipment used during the pm activities which will include iPad’s and Laptops and items needed for experiments, an inventory list will be furnished to CCL staff. Experiments will be conducted in the front of the Library.

Room #7 will be used for First Grade. Room #7 is located down the walkway from the library. The room has one entrance in the front left side and an exit in the left right corner. There is a door that leads to room #6 on the back-left corner and a door to room #7 on the right left corner. There is a working faucet and sink in the right back corner. The room has carbon monoxide detectors and fire sprinklers. There is a working phone on the right-hand side of the entrance.

The school playground will be used for outdoor activities. The playground is on the walkway headed south from library. The playground has four basketball courts and a large Jungle gym. The jungle gym has a fixed canopy that provides shade to the entire area. The play area will be used on staggered schedules by the different age groups.
There is a restroom located in room #1 behind the Parent Center and the Library. There is one sink and two toilets with partitions.

There are 2 girls and 2 boys restroom located next to the playground. There are 5 toilets and 4 sinks in each girl’s restroom. There are 4 sinks, 2 toilets and 4 urinals in each boy’s restroom. Restrooms offer privacy for use by the school-aged children. Staff have access to separate adult restrooms and there is a separate area to isolate children in case of illness.

The following items are required in order to consider a Provisional License:
- Three first Aid Kits (inventory list of items and picture)
- Three Carts with required postings, per Title 22 regulations, (picture)
- Picture of watery delivery method to be used (as many as need for the different areas that do not have accessible water)
- Facility sketch, updated to describe evacuation routes and areas used by facility.
- Emergency Disaster plan, updated.
- Phone number for facility (updated on LIC 200A)
- Board of Resolutions, authorizing the application for this license.
- Parent handbook and Admissions Agreement updated per office visit 08/14/2019. (cont"d Pg3

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Antonio Almanza	TELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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