198012408-4-21-2023-33-CC-AEIN-CR4PP9-20230421112909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012408
Report Date: 04/21/2023
Date Signed: 04/21/2023 11:29:25 AM

Document Has Been Signed on 04/21/2023 11:29 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:	PACIFIC AVENUE EDUCATION CENTER		FACILITY NUMBER:	198012408
ADMINISTRATOR:	STEPHANIE GUERRERO		FACILITY TYPE:	850
ADDRESS:	440 W. LOMITA AVE.		TELEPHONE:	(818) 547-0103
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91204
CAPACITY:	89	CENSUS: 46	DATE:	04/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Adriana Hernandez, Program Supervisor		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection on 04/21/23 at 8:45 AM. LPA met with Adriana Hernandez, Program Supervisor. LPA provided Program Supervisor with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). Program Supervisor guided LPA on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. This is a state preschool program which consists of 2 classrooms at this time; RM P1 (1107) 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 Adriana Hernandez, Program Supervisor currently there are 52 children enrolled. Per Adriana Hernandez, Program Supervisor currently RM 34 is occupied by School District Special Need Preschool program which will end by 06/7/23 and RM 35 is occupied by School age children. LPA informed Site Supervisor that based on Title 22 Regulations code 101212 (C)-- The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions. Per Site Supervisor, she will discuss RM 34 and 35 issues with school district and get back to LPA by 05/29/23 to let the LPA know if RM 34 and 35 will be kept under this license or not. Per Site Supervisor, Adriana Hernandez, School District Special Need Preschoolers use this program Outdoor activity space on staggered schedule. LPA informed Site Supervisor a wavier request to use the outdoor playarea on staggered schedule is required to be submitted to LPA by 05/29/23. All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection; Room 1107 (P1): Four staff with 31 preschoolers, Room 32: three staff with 15 preschoolers in the classroom. The facility was observed to be within the license capacity and limitations. 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: 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: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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: PACIFIC AVENUE EDUCATION CENTER	FACILITY NUMBER: 198012408
	VISIT DATE: 04/21/2023

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PHYSICAL PLANT
LPA observed the facility to be clean, safe, sanitary and in good repair. Per Site Supervisor cleaning crew clean the classrooms daily after school hours. 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. Linens are laundered by the facility each week on Friday or as needed. Napping equipment (cots) were observed to be stored in a cabinet within the classroom. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom. Per Program Supervisor children use water bottles indoor and outdoor. Teacher use water bottles to refill children's bottles.

Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Program Supervisor states there are no poisons stored at the facility. Per Program Supervisor there are connected carbon monoxide detector in each classroom. LPA observed required posting information were posted in each classroom by the entrance.

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. During this inspection LPA observed two big trees roots which are located in the grass area across from the administrative office, were accessible to the children which can be tripping hazards and grass area around the two big trees are not level. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Per Program Supervisor children take their water bottles outside during outdoor play time. LPA advised that no children shall be left without the supervision of a teacher at any time.

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: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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: PACIFIC AVENUE EDUCATION CENTER	FACILITY NUMBER: 198012408
	VISIT DATE: 04/21/2023

NARRATIVE

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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. Program Supervisor states there are no weapons or firearms on the premises.

FACILITY RECORDS

Program Supervisor, Adriana 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.

Ten Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPA also reviewed 5 staff records during this inspection. 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 46 children were present, and all 46 children were singed in. Disaster drill log was available, last drill was conducted on 04/12/23.

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. Per Program Supervisor, meals are prepared by Glendale Unified School District. Food are serviced in individual style. The facility provides AM and PM snack, and hot lunch. Children enrolled also have option to bring their own lunch.

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: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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
	VISIT DATE: 04/21/2023

NARRATIVE

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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 Nurse office. The ill child will use the staff restroom 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 IMS on file.

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 by 04/28/23.

LPA advised the licensee 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.
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.
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 12:00 PM.

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: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 04/21/2023 11:29 AM - 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: PACIFIC AVENUE EDUCATION CENTER	FACILITY NUMBER: 198012408
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)(1)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observations and Program Supervisor confirmation, the licensee did not comply with the section cited above and LPA observed two big trees roots which are located on the outdoor playarea across from the administrative office are enough out of the ground which can be tripping hazard for children which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/26/2023
	Plan of Correction
1 2 3 4	Per Program Supervisor she will ensure to fix the whole grass area around the two big trees in order to be safe and level for children to prevent tripping hazards.

Type B

Section Cited

CCR

101212(c)

The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Program Supervisor and LPA's observations Room 34 currently is used by School District Special Need Preschoolers and Room 35 is used by school age children, however Room 34 and Room 35 are licensed for this preschool program , the licensee did not comply with the section cited above and did not report classrooms changes to Licensing in a timely manner which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/26/2023
	Plan of Correction
1 2 3 4	Per Program Supervisors, she will discuss Room 34 and 35 issues with school district to decide if they are going to remove Room 34 and Room 35 from their license or not and send a written letter to LPA by plan of correction due date 05/26/23.

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 Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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