198005451-1-27-2023-33-CC-NTCG-CNGTBV-20230127133546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005451
Report Date: 01/27/2023
Date Signed: 01/27/2023 01:36:01 PM

Document Has Been Signed on 01/27/2023 01:36 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:	HOLY ANGELES PRE-K		FACILITY NUMBER:	198005451
ADMINISTRATOR:	GOANA, ELVIRA		FACILITY TYPE:	850
ADDRESS:	360 CAMPUS DR.		TELEPHONE:	(626) 447-6312
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	22	CENSUS: 13	DATE:	01/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:17 AM
MET WITH:	Elvira Gaona - Director		TIME COMPLETED:	01:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random annual inspection. Upon arrival at 11:17am, LPA met with Director Elvira Gaona. At 11:23am, LPA was led on a tour of the facility. This is a preschool program which consists of 1 classroom. The preschool is located on the campus of Holy Angels Catholic School (TK-8th). Per licensee, there are currently 15 enrolled in the program. Hours of operation for this facility are 7:45am-11:45am for school, and 11:45am-2:45pm for extended care, Monday- Friday.

Licensing staff observed all required forms/publications to be posted outside the classroom in the hallway. Facility does not have a snack menu as the families provide lunch and snack. Dry snacks are available for children who may have forgotten a snack.

PHYSICAL PLANT: At 11:23am, LPA entered and inspected Preschool Room: 13 children with 2 staff members. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children in a high cabinet in the kitchen. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects and rodents. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water was readily available indoors. At this time, the corner of the classroom is used as an isolation area. A mat is available for an ill child to rest on. First Aid supplies are available and complete. Facility has a functioning carbon monoxide detector that meets statutory requirements. Director states there are no weapons, firearms, or bodies of water on the premises. There is a restroom for children adjacent to the classroom. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly. There is a food preparation area (kitchen) that is also adjacent to the classroom that is clean, safe, and free of hazards.

REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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: HOLY ANGELES PRE-K	FACILITY NUMBER: 198005451
	VISIT DATE: 01/27/2023

NARRATIVE

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At 11:30am, LPA was shown the storage room in the hallway, next to the classroom. There were mats available for napping equipment and there were individually stored blankets/sheets for the children. In the storage room, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 12/08/2022. as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

OUTDOORS: At 11:35am, LPA reviewed the outdoor play area. Outdoor 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. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is one outside play space that has a bike path, play houses, play structure, sand box, and benches (where lunch is eaten. Drinking water is readily available outdoors.

Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher during tour. The Licensee is within the conditions, limitations, and capacity specified on the license. All areas were identified on the Facility Sketch were inspected.

FACILITY RECORDS: 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. Disaster drills have been conducted at least every six months. Staff files were reviewed for a health screening report and immunizations that meet regulatory requirements. Criminal Record Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. At 12:17pm, LPA observed that 1 of 2 staff members' personnel files was unable to be located. LPA discussed the importance of the file needing to be present on site and accessible for review by the department. Per director, they believe that the main school office may have misplaced the staff members file. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed. At 12:25pm, LPA observed that 2 of 2 staff members did not have up to date Mandated reporter Child Care Provider (Ab1207) training complete. LPA explained that the training had to be completed every two years. A random sample of Children’s Records were reviewed to ensure that they are complete.

REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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: HOLY ANGELES PRE-K	FACILITY NUMBER: 198005451
	VISIT DATE: 01/27/2023

NARRATIVE

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INCIDENTAL MEDICAL SERVICES:
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.htm

Licensee 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.

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

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted with Elvira Gaona, at 1pm, and Plan of Corrections were reviewed and developed. Copy of report provided. END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 01/27/2023 01:36 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: HOLY ANGELES PRE-K	FACILITY NUMBER: 198005451
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and records review, the licensee did not comply with the section cited above in 2 out of 2 staff files, Staff #1-2's files, did not have an up to date Mandated Reporter Child Care Provider (AB1207) proof of completion, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/03/2023
	Plan of Correction
1 2 3 4	Per director, staff will complete Mandated Reporter Child Care Provider (AB1207) Training and send proof of completion to LPA by POC date.

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and records review, the licensee did not comply with the section cited above in 1 out of 2 Staff files, Staff #2, was not present on site and accessbile for LPA to review, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	Per Director, they will have obtain all the completed forms and ensure the file is kept available. Director will scann all completed forms to LPA by POC date.

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC809 (FAS) - (06/04)

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