198015514-4-29-2022-33-CC-FVAZ-CDXRHY-20220429130308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015514
Report Date: 04/29/2022
Date Signed: 04/29/2022 01:03:16 PM

Document Has Been Signed on 04/29/2022 01:03 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:	BPUSD - NORTH PARK HIGH SCHOOL		FACILITY NUMBER:	198015514
ADMINISTRATOR:	JERRI SANDELL		FACILITY TYPE:	830
ADDRESS:	4600 N. BOGART AVENUE		TELEPHONE:	(626) 962-3311
CITY:	BALDWIN PARK	STATE: CA	ZIP CODE:	91706
CAPACITY:	40	CENSUS: 11	DATE:	04/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Elizabeth Gaitan , Early Head Start Supervisor,		TIME COMPLETED:	01:15 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	On 04/29/22 at 8:35 Licensing Program Analyst (LPA) Fabiola Vasquez conducted an unannounced Annual/Required inspection. At approximately 8:40 AM LPA Vasquez began a facility tour with Head Teacher Sara Barron. All areas identified on the facility sketch were inspected. This is an infant program with a toddler component which is licensed for 40 children; 25 infants and 15 toddlers. The facility operates Monday – Friday from 8:00 AM – 3:00 PM. At 9:09 AM Elizabeth Gaitan, Early Head Start Supervisor, arrived to complete the inspection. Per Supervisor there are 20 children enrolled. Covid Precautionary Measures are being conducted at the main entrance of the High School. LPA observed a total of 11 children with 8 staff. In the Infant Room 01 with 03 staff, Wobblers Room, 03 infants with 02 staff, , Toddlers Room, 07 toddlers with 03 staff. Toddler and infant rooms are conducted in physically separate areas both indoors and outdoors. All children were observed to be playing. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. During this inspection, all children were observed to be under visual supervision of a teacher at all times. LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, Snack Menus, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed dated: 04/05/22. PAGE 1 OF 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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: BPUSD - NORTH PARK HIGH SCHOOL	FACILITY NUMBER: 198015514
	VISIT DATE: 04/29/2022

NARRATIVE

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LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, the isolation area is located in the same area where the office is, labeled Isolation area. There is also a space in each room that can be used, if needed.
Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Infant Care: LPA observed age appropriate furniture and equipment, but not limited to cribs, cots, mats; changing tables, and feeding chairs. LPA observed and inspected sleeping equipment to ensure there is a sufficient amount. LPA observed that cribs and/or play yards are free from loose articles and objects. There are no objects hanging above or attached to the side of the crib. Pacifiers were observed to not be attached to anything and are labeled. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.

Title 22 Regulation Section 101429(a)(2)(b) Responsibility for Providing Care and Supervision for Infants was discussed with the Licensee, including but not limited to documentation that shall be maintained. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was reviewed. A feeding plan is on file for each infant. An Infant Needs & Services Plan is on file for each file reviewed.

Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides Breakfast, Lunch and PM snack. Parents of infants in care provide all items such as formula and diapers. LPA observed all food items and bottles labeled with each child's specified name. LPA observed water pitchers in each room. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Fire extinguisher ex-date: 07/07/22.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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: BPUSD - NORTH PARK HIGH SCHOOL	FACILITY NUMBER: 198015514
	VISIT DATE: 04/29/2022

NARRATIVE

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Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA observed age appropriate toys and equipment for infants in care. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Supervisor states there are no weapons or firearms on the premises.

Sign in and out sheets will be reviewed on another day in the BPUSD ECE office 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 was unable to observed all children present to be signed in.

Staff Records: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, health preventive practices documented, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights. Per Supervisor records are located at BPUSD ECE OFFICE address: 13307 Francisquito Ave Baldwin Park Ca 91706. LPA will review reports on a different day.

Children’s Records: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record. Per Supervisor records are located at BPUSD ECE OFFICE address: 13307 Francisquito Ave Baldwin Park Ca 91706. LPA will review reports on a different day.

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.html

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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: BPUSD - NORTH PARK HIGH SCHOOL	FACILITY NUMBER: 198015514
	VISIT DATE: 04/29/2022

NARRATIVE

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LPA discussed the safe sleep regulations with Supervisor, Elizabeth Gaitan and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.

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

There were no deficiencies given during this inspection.

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 Supervisor, Elizabeth Gaitan.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC809 (FAS) - (06/04)

Page: 4 of 4