198015976-6-17-2020-33-CC-RLOZ-BQNR5L-20200617124319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015976
Report Date: 06/17/2020
Date Signed: 06/17/2020 12:43:35 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:	CLAREMONT ABC FOR ME PRESCHOOL		FACILITY NUMBER:	198015976
ADMINISTRATOR:	ADETAYO ABON		FACILITY TYPE:	850
ADDRESS:	1700 DANBURY RD.		TELEPHONE:	(909) 730-7181
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	37	CENSUS: 10	DATE:	06/17/2020
TYPE OF VISIT:	Case Management - Incident	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alicia Rodriguez, Assistant Director		TIME COMPLETED:	11:30 AM

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	An announced Case Management Inspection was conducted by Licensing Program Analyst (LPA) Roxana Lopez. Due to COVID-19 and precautionary measures this Case Management Inspection was conducted with Assistant Director, Alicia Rodriguez via tele-inspection by the use of face-time. The purpose of today’s inspection is to follow up on an incident that was reported to the Department on 02/03/2020. During this tele-inspection Assistant Director took LPA on a tour of the facility. Census was taken. On 02/03/2020, an incident was reported to the department where a child was having a hard time sleeping and was taken to the office. Child eventually fell asleep- fifteen minutes after nap time employee noticed medication missing from her backpack. Parents were called and child was taken to the Emergency Room, test were done and it was found that there was no trace of medication in child’s body. The facility reported this incident to the Department within the required 24 hours. During this inspection LPA interviewed staff # 1-3. Staff # 1 reported incident, per Staff # 1 training has been provided and a safe area has been created to store staff belongings. Interviews with Staff # 2 and 3 concurred with Staff # 1 statements. During tele-inspection LPA observed the office where the incident took place. A cabinet with high shelves has been designated for staff to store their personal belongings. The Assistant Director has recently moved offices, the office close to the classroom remains closed during the day. Per Assistant Director and order to put locks on cabinets has been placed, but it is delayed due to COVID-19. During inspection napping procedures were discussed. LPA obtained and reviewed documentation. Based on the information obtained and LPA observation of the area, LPA determined there was adequate supervision provided the day of the incident. ---------------------------------------------------Page 1 of 2 --------------------------------------------------------------------------------

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020

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: CLAREMONT ABC FOR ME PRESCHOOL	FACILITY NUMBER: 198015976
	VISIT DATE: 06/17/2020

NARRATIVE

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Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

Notice of Site Visit (LIC9213) shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit Interview conducted with Alicia Rodriguez, via tele-inspection face-time, during which appeal rights were explained. This report along with a copy of appeal rights will be sent to the licensee via email with a read receipt or confirmation of receipt email, which will act as license’s signature.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020

LIC809 (FAS) - (06/04)

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