197494283-8-12-2021-30-CC-LSTN-C5TQCG-20210812120307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494283
Report Date: 08/12/2021
Date Signed: 08/12/2021 12:03:18 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:	ROSEL, MARTHA		FACILITY TYPE:	840
ADDRESS:	5213 CREBS AVE		TELEPHONE:	(818) 345-1090
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	110	CENSUS: 0	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Elizabeth Gallegos		TIME COMPLETED:	12:20 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 8/12/2021 Licensing Program Analyst (LPA) Laticia Thompson, conducted an unannounced Annual Required Inspection for the school age license. This license was granted to Scott Bartholomew whom is the owner of this before and after school program located on LAUSD school grounds. Upon arrival to the facility the director was unavailable due to school is currently on break. Director will be available on 08/13/2021 and in full capacity when school resumes on 08/16/2021. LPA contacted Scott Bartholomew by phone and explained to him to purpose of the visit. The licensee gave permission to Elizabeth Gallegos to guide LPA on a tour of the rooms being utilized by the licensee. LPA toured the facility indoors and outdoors. Days and hours of operation are M-F 7am-8am & 2pm-6pm, Tuesday 7am-8am & 1pm-6pm in the Parent Center and in the Library. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items will be made inaccessible when school resumes. All poisons will be kept in a locked storage area. Cleaning solution were observed during the inspection while school is being disinfected there were no children present.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: 08/12/2021

NARRATIVE

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Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children are toxic free. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. There was no food or kitchen to inspect. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The Department has inspection authority as specified in Health & Safety Code. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply with the department’s exclusion order. Capacity and limitations as specified on the license are being maintained. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 14 children in care.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: 08/12/2021

NARRATIVE

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Licensee will provide the following by 08/16/2021

· A current copy of a certificate of at least one person trained in CPR and Pediatric First Aid. This person must be present when children are at the facility or at offsite activities.

· A sample of children’s files with contact information for authorized representative and or relatives or others who can assume responsibility for the child and immunization records

· A sample of staff files with educational background, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: 08/12/2021

NARRATIVE

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LPA discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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