198004826-4-20-2023-33-CC-AEIN-CR3PKC-20230420112256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004826
Report Date: 04/20/2023
Date Signed: 04/20/2023 11:23:03 AM

Document Has Been Signed on 04/20/2023 11:23 AM - 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:	JEFFERSON STATE PRESCHOOL PROGRAM		FACILITY NUMBER:	198004826
ADMINISTRATOR:	HILDA AVANESIAN		FACILITY TYPE:	850
ADDRESS:	1540 FIFTH STREET, RM #6103		TELEPHONE:	(818) 243-4279
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91201
CAPACITY:	24	CENSUS: 20	DATE:	04/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Adriana Hernandez, Program Supervisor		TIME COMPLETED:	11:50 AM

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) Anomeh Eivazian conducted an unannounced Required - 1 Year inspection on 04/20/23 at 8:40 AM. Upon LPA's arrival to the facility LPA met with teachers Viviana Alquisiras, Hilda Sahakian and Sunitha Alagalas. Teacher Hilda Sahakian guided LPA on a tour of the facility. At 9:20 AM Adriana Hernandez Program Supervisor arrived to the facility. LPA provided Adriana Hernandez with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). At 9:45 Alison Beecher. program supervisor arrived to the facility and brought staff files from school district for review. A COVID 19 risk assessment was conducted prior to entering the facility. This is a preschool program which consists of 1 classroom, classroom 6103. This facility is located on Jefferson State Elementary property. The program operates Monday - Friday (2) Sessions, 8:30AM to 11:30AM and 12:30PM to 3:30PM. Parents enter the facility thought the gate which is located on the Ruberta Ave. and leads to the preschool classroom. All areas identified on the Facility Sketch were inspected. Upon arrival LPA observed 20 children were present in the classroom with 3 staff. The facility was observed to be within the license capacity and limitations. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. The following was observed during the tour of the facility: PHYSICAL PLANT LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for age appropriateness and good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials accessible to children were observed to be toxic-free. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings in the classroom. Per teacher Viviana Alquisiras, children do not take nap in this program. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. REPORT CONTINUES ON NEXT PAGE 1 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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: JEFFERSON STATE PRESCHOOL PROGRAM	FACILITY NUMBER: 198004826
	VISIT DATE: 04/20/2023

NARRATIVE

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Availability of indoor drinking water was observed in the classroom. Per Adriana Hernandez, Program Supervisor teachers refill children water bottles by using water bottles and children use their water bottles indoor.

Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Per Program Supervisor, Adriana Hernandez there are no poisons stored at the facility. Per Program Supervisor there is a operable connected carbon monoxide detector in the classroom. LPA observed required posting information were posted in classroom by the entrance door. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.

Outdoor playground equipment is in a 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. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand and grass cushioning material that absorbs a fall; climbing apparatuses are single level only. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. LPA observed children took their water bottles outside during this inspection. LPA advised that no children shall be left without the supervision of a teacher at any time.

The Program Supervisor states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this inspection. The Program Supervisor states there are no weapons or firearms on the premises.

FACILITY RECORDS

Program Supervisor, Andrea Hernandez 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. Six Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

REPORT CONTINUES ON NEXT PAGE 2 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: JEFFERSON STATE PRESCHOOL PROGRAM	FACILITY NUMBER: 198004826
	VISIT DATE: 04/20/2023

NARRATIVE

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There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present had proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present had proof against TB, measles, pertussis, and influenza. All staff have been given on the-job training sanitation principles, housekeeping, including universal health precautions.

Children's roster was reviewed and is current. 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 sign in/out sheet was placed outside by the entrance door. During this inspection 20 children were present, and all 20 children were singed in. Disaster drill log was available, last drill was conducted on 2/28/23.

Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. Facility provides lunch to AM and PM session, Meals provided by Glendale School District.

First Aid supplies were observed in the classroom in a cabinet. According to program supervisor, medication is only administered to a child when accompanied with a doctor's note and is stored in the child’s classroom. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the main office, nurse room. The ill child will use the staff bathroom of the school during isolation which is disinfected immediately after use per Site Supervisor.

Medication: 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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.htm. Plan of operation for Incident Medical Services is on the file.

REPORT CONTINUES ON NEXT PAGE 3 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: JEFFERSON STATE PRESCHOOL PROGRAM	FACILITY NUMBER: 198004826
	VISIT DATE: 04/20/2023

NARRATIVE

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Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Per Program Supervisor, water lead testing was completed on 04/13/23. LPA asked program supervisor to submit labeled facility sketch LIC 999, LIC 9275 and LIC 9276 to LPA Eivazian by 04/29/23. LPA informed program supervisor the cafeteria water faucet which is used to wash fruits is required to be tested as well.

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

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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Program Supervisor, Adriana Hernandez at 11:50 AM.

END OF REPORT PAGE 4 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

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