198002432-9-8-2023-33-CC-CTUA-CVGS88-20230908133843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198002432
Report Date: 09/08/2023
Date Signed: 09/08/2023 01:39:34 PM

Document Has Been Signed on 09/08/2023 01:39 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:	HACIENDA-LA PUENTE USD		FACILITY NUMBER:	198002432
ADMINISTRATOR:	J. MONYEI, R. KHANA		FACILITY TYPE:	850
ADDRESS:	15540 FAIRGROVE AVE.		TELEPHONE:	(626) 933-1380
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	44	CENSUS: 27	DATE:	09/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ryan Martinez		TIME COMPLETED:	01:00 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	On September 8, 2023, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced required 1-year inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPA entered facility through the Fairgrove Academy (K-8^th grade) school’s front office and was escorted towards the back of the school to enter through a gate into the preschool programs. LPA met with teacher, Elizabeth Lazo and LPA took the Head Start preschool program census of 11 children and 3 staff in care and the State preschool's census of 16 children and 3 staff in care. The preschool programs operate as a Head Start Preschool and a State Preschool. LPA called and spoke to the main office that is located off-site. At approximately 10:00 am Site Supervisor, Ryan Martinez who oversees the preschool programs arrived and met with LPA to facilitate the visit. Hours of operation: The days and hours of operation for Head Start Preschool are Monday-Friday, 8:00 A.M.-2:00 P.M. and the State Preschool is -Friday, 8:15 A.M.-11:15 A.M. Location: There are 3 portables: (Room 36 (State Preschool) is adjacent to room 40, which is a Kindergarten class which is not covered under this license.). The other portable (HeadStart Preschool Classroom) is the HeadStart preschool. Both classrooms are located in "portables" on the site of Fairgrove Academy School which accommodates children Kindergarten thru 8th grade. The portables are located on the south side of the Fairgrove Academy. The playground is shared with kindergarten and combo Kindergarten and 1^st grade classes. The preschool programs are on a different schedule from the K/1^st grade classes so that there is no commingling. The portables and the playground are surrounded by a chain link fence which are separate from the Academy. Page 1 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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: HACIENDA-LA PUENTE USD	FACILITY NUMBER: 198002432
	VISIT DATE: 09/08/2023

NARRATIVE

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The Head Start portable is one large classroom with a restroom for the children, one staff restroom, an adult size sink for hand washing located outside the staff restroom, a kitchenette which contains a full-size refrigerator, and one office for the staff. The State Preschool portable is one large classroom with a restroom for the children. The Staff in that classroom use the staff restroom in the HeadStart Classroom. They do not have a kitchenette; however, they do have a small refrigerator to store medication for children in care and and adult size sink for hand washing. To gain access to the school there is a side gate for parents to drop-off and pick-up children.

All posting requirements were observed on the Parent Boards which is located on the wall adjacent to the door through which the children will enter. There is a copy of the monthly menu posted inside each portable adjacent from the door and menus are available on the website and emailed to parents. All food is provided by the School District. HeadStart Preschool’s meals are breakfast served at 8:00 am, lunch at 11:00 am and P.M. snack at 1:30 pm. The State preschool has breakfast served at 8:30 am.

There is currently five children who require medication, which is currently stored in a locked cupboard up high in the classroom locked with a chain and a padlock, out of reach of children. LPA observed medication is not expired and required paperwork was stored with the medication. Head Start Portable has a First Aid Kit in the kitchen cabinet which is labeled with a sign and State portable has the First Aid stored in a cabinet. HeadStart program keeps cleaning supplies in the cabinet above the kitchen sink in the kitchenette; it is locked with a chain and padlock. State preschool keeps their cleaning supplies in a locked cabinet inside the classroom with a chain and padlock.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

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: HACIENDA-LA PUENTE USD	FACILITY NUMBER: 198002432
	VISIT DATE: 09/08/2023

NARRATIVE

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There is a carbon monoxide and smoke detectors that are connected to the elementary school and are tested by the school district through-out the year. The last annual maintenance on the Fire Extinguisher was on August 8, 2023. Fire Drill was last conducted and documented on September 5, 2023.

LPA reviewed parent sign-in/out sheets and found that they are recording time of drop-off and pick-up and were reminded to use full signature for children in care.

The children's restrooms have two toilets, and 2 child-size sinks which are located inside the restrooms. There is also a small sink with drinking fountain attached located outside of the children’s restroom. According to the Teacher the children bring water from home each day and they have extra water bottles to refill as needed. The adult restroom will be used by staff. Children in the HeadStart program currently nap and there is napping equipment stored in the classroom and cots are sanitized each day. The children bring napping items from home and are sent back at the end of the week for laundering.

LPA referred Site Supervisor to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPA reminded Site Supervisor regrading the PIN 21-21.1-CCP for written directives of Lead Testing.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 09/08/2023 01:39 PM - It Cannot Be Edited

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: HACIENDA-LA PUENTE USD	FACILITY NUMBER: 198002432
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on the interview, the licensee did not comply with the section cited above in not having the lead testing completed by the due date of January 1, 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/09/2023
	Plan of Correction
1 2 3 4	According to the Site Supervisor, Ryan Martinez the preschool programs are part of a school district and are working in conjunction with the district to conduct the lead testing in the kitchnette sinks and water fountains.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: HACIENDA-LA PUENTE USD	FACILITY NUMBER: 198002432
	VISIT DATE: 09/08/2023

NARRATIVE

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Site Supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor, Ryan Martinez.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023

LIC809 (FAS) - (06/04)

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