198001552-5-13-2022-33-CC-FVAZ-CEDVHY-20220513162756

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198001552
Report Date: 05/13/2022
Date Signed: 05/13/2022 04:29:03 PM

Document Has Been Signed on 05/13/2022 04:29 PM - It Cannot Be Edited

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:	PACIFIC OAKS CHILDREN'S SCHOOL		FACILITY NUMBER:	198001552
ADMINISTRATOR:	ROBERT BOYMAN		FACILITY TYPE:	850
ADDRESS:	714 W. CALIFORNIA BLVD.		TELEPHONE:	(626) 529-8011
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY: 140	TOTAL ENROLLED CHILDREN: 140	CENSUS: 93	DATE:	05/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Victor Soto, Associate Director		TIME COMPLETED:	03:00 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 Analyst (LPA) Fabiola Vasquez conducted an unannounced Required I year inspection. LPA met with Associate Director (AD), Victor Soto. This is a preschool program which is licensed for 141 preschool children. At approximately 8:50 AM LPA Vasquez began facility tour with AD. All areas identified on the facility sketch were inspected. During this inspection LPA observed in the Adventure room 14 children with 2 staff, Bambo room 14 children with 3 staff, Boat room 13 children with 3 staff, El Arroyo 10 children with 3 staff, La Loma (Part Day) 10 children with 2 staff, La Loma (Full Day) 10 children with 2 staff, La Tierra 13 children with 2 staff, Peppers 09 children with 3 staff. Total census: 93 children with 20 staff. The facility operates Monday – Friday from 8: 00 to 5:00. Per the Director there are 127 children enrolled. Covid Precautionary Measures are being conducted at the main entrance of the facility. Executive Director, Judy Krause (ED) arrived at approximately 11:20 AM who continued with the inspection. All children were observed to playing indoors and outdoors. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. Criminal Record Clearances were reviewed. During this inspection, all children were observed to be under visual supervision of a teacher at all times. LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed dated: 04/22/22. PAGE 1 OF 3

Claudia Guangorena
Fabiola Vasquez
	DATE: 05/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022

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: PACIFIC OAKS CHILDREN'S SCHOOL	FACILITY NUMBER: 198001552
	VISIT DATE: 05/13/2022

NARRATIVE

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LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, there is an Isolation Room right next to the Reception office. Across is a restroom for sick children to use if needed. Parents are contacted immediately when children are determined to be ill, and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Snack menus was not observed, per ED the school was providing snacks prior to covid. Currently snacks have not been provided since 9/2020. Parents were notified via parent handbook. ED was informed that snacks are required to be provided for a full day program. Per ED parents will be notified that the school will be providing snacks and menus will be posted on 5/16/22, snack will be provided the week of 5/23/22.

A Technical Violation was provided to ED.

LPA observed individual water containers that children bring from home. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Fire extinguisher ex-date: 4/16/22.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed age appropriate toys and equipment for infants in care. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Director states there are no weapons or firearms on the premises.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed all children present to be signed in. Staff Records were reviewed and discussed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, (EX: 8/27/23), health preventive practices documented, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate (EX: 7/13/22), and the LIC 9052 Notice of Employee’s Rights.

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SUPERVISOR'S NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022

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: PACIFIC OAKS CHILDREN'S SCHOOL	FACILITY NUMBER: 198001552
	VISIT DATE: 05/13/2022

NARRATIVE

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Children’s Records were reviewed and discussed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.html

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There were no deficiencies given during this inspection.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report and appeal rights were reviewed with the Executive Director, Judy Krause.

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SUPERVISOR'S NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022

LIC809 (FAS) - (06/04)

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