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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012408
Report Date: 11/07/2019
Date Signed: 11/07/2019 01:56:35 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:PACIFIC AVENUE EDUCATION CENTERFACILITY NUMBER:
198012408
ADMINISTRATOR:STEPHANIE GUERREROFACILITY TYPE:
850
ADDRESS:440 W. LOMITA AVE.TELEPHONE:
(818) 547-0103
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY:89CENSUS: 46DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Perla Leyvas, Program SupervisorTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Anomeh Eivazian and Bardo Baluyot conducted an unannounced random inspection. Upon LPAs arrival to the facility LPAs met with Karen-happuch Hernandez, head teacher. Ms. Hernandez contacted School District to inform about licensing inspection. Perla Leyvas, Program Supervisor arrived during this inspection and brought staff files from main office. Ms. Hernandez provided children's files for review upon request. This is a preschool program which consists of 2 classrooms at this time; RM P1 and RM 32. This facility is located on Pacific Avenue Education Center property that belong to Glendale Unified School District. Facility operation hours are from Monday to Friday from 6:30 AM to 6:00 PM. Per Perla Leyvas, Program Supervisor currently there are 51 children enrolled.

All areas identified on the Facility Sketch were inspected. The following staff were present during this inspection: RM P1: 5 Staff with 32 preschoolers and RM 32: 3 staff with 14 preschoolers. The following was observed during tour of facility:

PHYSICAL PLANT


Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were accessible to children in kitchen area in RM P1. LPAs observed a dish soap in RM P1 under the sink cabinet while the cabinet door was closed but it was not locked. Ms. Hernandez states there is no poison on the premises, but does understand that if any poison is purchased, it is required to be locked with a key or combination lock. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing sinks are safe, sanitary and are operating properly. All floors are clean and safe. LPAs observed the colorful and foxy green carpet in RM 32 with soiled black stains.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair.
REPORT CONTINUES ON THE NEXT PAGE 1 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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 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: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408
VISIT DATE: 11/07/2019
NARRATIVE
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Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors. LPAs observed water fountains both indoors and outdoors. The facility was observed to be free of flies, other insects and rodents.

Napping equipment and bedding was inspected for good condition, appropriate storage and cleanliness. Storage for children's belongings was inspected. Parents take blankets home on Friday and returned on Monday, and children's linens being washing in the facility once a week. The Nurse office will be used by ill children. There is a napping cot available for an ill child. The Nurse restroom will used by ill children.

Teacher child ratios were observed and staff names recorded. Sign in and out sheets were reviewed.

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. However, LPAs observed roots of two big trees on playground were out of ground which are tripping hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. LPAs observed the edge of cushioned matrical under and around play structure is needed to be fixed to prevent tripping hazards. There is adequate shade in the play yard. Preschoolers share the outdoor playground with Special Education Preschoolers on a staggered schedule.

Per Site Supervisor, there are no pets, weapons, firearms or bodies of water on the premises. There is a land line on the premises.

FACILITY RECORDS
All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. 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 and mandated reporter training for each staff present are on file and were reviewed. Six staff files were reviewed during this inspection and files were completed.

Staff and Children’s Records were reviewed for completeness; Inspection of required forms was made During this inspection. 10 random children's files were reviewed and completed.
REPORT CONTINUES ON THE NEXT PAGE 2 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 2 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: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2019
Section Cited

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Indoor Activity Space. The floors of all rooms shall have a surface that is safe and clean. This requirement has not been met as evidenced by LPAs tour of the facility. LPAs observed soiled stains on colorful and green foxy carpets in RM32. (Pictures were taken). This poses a potential risk to the health and safety of children in care.
Type B
12/13/2019
Section Cited

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Buildings and Grounds
Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
This requirement has not been met as evidenced by LPAs tour of the facility. LPAs observed a dish soup under the sink
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cabinet in RM P1.LPAs observed the cabinet door was closed but it was not locked.
This poses a potential risk to the health and safety of children in care.
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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: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 5 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: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408
VISIT DATE: 11/07/2019
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Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 10/17/19.
Snack 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. Per Program Supervisor, meals are prepared by Glendale Unified School District. Food are serviced in family style. The facility provides AM and PM snack, and hot lunch. Children enrolled also have option to bring their own lunch.

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 to provide IMS was submitted on 07/17/17.

LPAs advised the Program Supervisor to access forms, regulations, quarterly updates, and providers information notices on the Child Care Licensing website at: www.ccld.ca.gov. LPAs provided and explained Effects of Lead Exposure flyer.

Based on this information, the following deficiencies listed on the attached LIC 809d are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited 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. Failure to maintain posting as required will result in a civil penalty of $100.00.
Exit interview was conducted with Perla Leyvaz, Program Supervisor, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
REPORT END 3 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 3 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: PACIFIC AVENUE EDUCATION CENTER
FACILITY NUMBER: 198012408
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2019
Section Cited

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Outdoor Activity Space. The surface of the outdoor activity space shall be maintained:
In a safe condition for the activities planned.
This requirement has not been met as evidenced by LPAs tour of the facility. LPAs observed roots of two trees on outdoor playground were out of ground and
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are tripping hazards.
This poses a potential risk to the health and safety of children in care.
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Type B
12/13/2019
Section Cited

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Outdoor Activity Space. The surface of the outdoor activity space shall be maintained:
In a safe condition for the activities planned.
This requirement has not been met as evidenced by LPAs tour of the facility. LPAs observed the edges of cushioned materials around and under climbing
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structure on playground are needed to be fixed to prevent tripping hazards. (Pictures were taken).

This poses potential risk to the health and safety of children in care.
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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: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5