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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010850
Report Date: 05/22/2019
Date Signed: 05/22/2019 06:41:53 PM

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:MT VIEW PRESCHOOL/CLAREMONT UNIFIED SCHOOL DIST.FACILITY NUMBER:
198010850
ADMINISTRATOR:HILARIE DYSON, ED.D.FACILITY TYPE:
850
ADDRESS:851 SANTA CLARA AVENUETELEPHONE:
(909) 398-0308
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:24CENSUS: 17DATE:
05/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Child Development Director Dr. Hilarie Dyson TIME COMPLETED:
06:40 PM
NARRATIVE
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An unannounced Case Management-Incident inspection was conducted on this date by Licensing Program Analyst (LPA) Emiko Bell to follow up on an Unusual Incident which occurred on 05/06/19 and was reported via U.S. Mail to Community Care Licensing on 05/20/19. Child Development Director Dr. Hilarie Dyson was phoned by Ms. Martinez and arrived at the premises at 10:00 A.M.

Upon arrival, LPA was greeted and let into the gate which surrounds the Center by Paraeducator Stephanie Martinez, who was on the playground. There were 17 children with the Lead Teacher, a Special Education teacher and a Paraeducator. Claremont Unified School District operates under Title 5 ratio. Staff-child ratio was met. (There were additional staff and therapists present, for a total of four additional adults, but they do not count in ratio,.

The Unusual Incident which was reported that occurred on 05/06/19 was that Child #1 got out of the classroom and the gate surrounding the Center and was escorted back to the Center by another parent.

During today's visit, interviews were conducted in-person on-site with five staff. Documentation in the form of a photocopy of the "Preschool Registration Form" and the "Child's Preadmision Health HIstory-Parent's Report (form LIC 702) for Child #1 were obtained. Photos were taken by LPA.

The Center is being cited for the following: Lack of Supervision as the child was able to exit the classroom and the gate surrounding the Center without a staff noticing; Reporting Requirements, as the incident was not reported to CCL until 05/20/19; and Reporting Requirements, as the incident was not reported to the child's parent until three days later (and not by Center staff, but by the parent who returned the child to the Center.)
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: MT VIEW PRESCHOOL/CLAREMONT UNIFIED SCHOOL DIST.
FACILITY NUMBER: 198010850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2019
Section Cited
CCR
101229(a)(1)
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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION
The licensee shall provide care and supervision as necessary to meet the children's needs.No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Child Development Director Dyson stated that measures have been put in place to prevent reoccurence.
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-This requirement is not met as evidenced by: On 05/06/19, a child left the classroom and exited the Center gate. The child was returned to the Center by another parent. The duration the child was gone is undetermined. *A civil penalty is not being assessed as the Licensee is a Public Agency.*
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 4 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: MT VIEW PRESCHOOL/CLAREMONT UNIFIED SCHOOL DIST.
FACILITY NUMBER: 198010850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2019
Section Cited
CCR
101212(d)
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REPORTING REQUIREMENTS
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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Child Development Director Dyson stated that all staff will be instructed to report any incidents immediately to the Lead, who will then report it to the Child Development Director.
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-This is requirement is not met as evidenced by: On 05/06/19, a child left the classroom and exited the Center gate. This was reported to CCL in an Unusual Incident Report sent via US mail which was received by CCL on 05/20/19, missing both the 24 hour and the seven day reporting requirement.
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Type B
05/24/2019
Section Cited
CCR
101212(f)
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REPORTING REQUIREMENTS
The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative.

-This is requirement is not met as evidenced by: On 05/06/19, a child left the classroom and exited the Center gate, which leads to
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Child Development Director Dyson and staff agreed to inform staff at the beginning of each school year that all incidents must be immediately (or as soon as possible) reproted to the parents. A staff meeting will be held and an Agenda and a sign-in sheet will be provided to CCL reiterating this.
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the parking lot. The child's parent
was informed on 05/09/19 by the parent who found and returned the child and not by the two staff who were in the classroom at the time the child left and was returned.
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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: MT VIEW PRESCHOOL/CLAREMONT UNIFIED SCHOOL DIST.
FACILITY NUMBER: 198010850
VISIT DATE: 05/22/2019
NARRATIVE
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Upon receipt, the Licensee shall post the Notice of Site Visit and the Licensing report. This report and the Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next twelve (12) months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

An exit interview was conducted with, and a copy of the report has been signed by and provided to Child Development Director Dr. Hilarie Dyson. Appeal Rights have been provided and explained to Dr. Hilarie Dyson.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4