<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017084
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:40:19 PM

Document Has Been Signed on 01/12/2023 01:40 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:HORACE MANN EARLY EDUCATION AND EXTENDED L.P.FACILITY NUMBER:
198017084
ADMINISTRATOR:DEIDRE CORWINFACILITY TYPE:
850
ADDRESS:501 E. ACACIA AVENUETELEPHONE:
(818) 247-0775
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 24TOTAL ENROLLED CHILDREN: 22CENSUS: 19DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Perla Leyvas, Program SupervisorTIME COMPLETED:
02:00 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 required- 1 year inspection on 01/12/23 at 9:00 AM. Upon arrival LPA met Aydee Salas, teacher of RM 2101 who stated she called the CDCC office and Program Director is on her way. LPA waited in RM 2101. At 9:40 AM teacher assistant, Irma Khodaverdian guided LPA on a tour of the facility. At 9:50 AM Deidre Corwin, Program Director/Site Supervisor and Perla Leyvas, Program Supervisor arrived to the facility. LPA provided Deidre Corwin, Program Director with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). This is a preschool program which consists of 1 classroom, RM 2101. This facility is located on Horace Mann Elementary school property. Facility operation hours are from 6:30 AM to 6:00 PM. There is a kindergarten program on the premises that share the same outdoor activity space with preschool program. Waiver on the file.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection; Preschool Room 2101: Two staff with 19 preschoolers in the classroom. At 10:30 AM four staff were present in the classroom with 19 children. The facility was observed to be within the license capacity and limitations. Staff names were recorded. 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:

PHYSICAL PLANT
LPA observed the facility to be clean, safe, sanitary and in good repair. Clearing crew clean the facility daily after 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 in the classroom. Parents take Linens home each week on Friday or as needed and return it on Monday. During
REPORT CONTINUES ON NEXT PAGE 1 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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 6
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: HORACE MANN EARLY EDUCATION AND EXTENDED L.P.
FACILITY NUMBER: 198017084
VISIT DATE: 01/12/2023
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
26
27
28
29
30
31
32
this inspection LPA observed children used bedding comes into contact with other bedding. (Pictures taken).Napping equipment (cots) were observed to be stored in 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.

Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Per Perla Leyvas, Program Supervisor there are no poisons stored at the facility. Per Perla Leyvas, Program Supervisor there is working carbon monoxide detector in the classroom which is connected to the fire alarm. It sounded off the alarms and heard by LPA to be functional. LPA observed required posting information were posted in the classroom by the entrance door. 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 rubber cushioning material that absorbs a fall; climbing apparatuses are single level only. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Per Site Supervisor, Deidre Corwin, children take their water bottlers outside during outdoor play time. LPA advised that no children shall be left without the supervision of a teacher at any time.

The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this inspection. Director states there are no weapons or firearms on the premises.

FACILITY RECORDS


Program Supervisor, Perla Leyvas 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.
Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.
REPORT CONTINUES ON NEXT PAGE 2 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: HORACE MANN EARLY EDUCATION AND EXTENDED L.P.
FACILITY NUMBER: 198017084
VISIT DATE: 01/12/2023
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
26
27
28
29
30
31
32
There is at least one person trained in CPR and Pediatric First Aid present during this inspection. LPA also reviewed staff records. 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 classroom entrance door. During this inspection 19 children were present, and only 15 children were singed in. Disaster drill log was available, last drill was conducted on 12/15/22.

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. Preschoolers are provided AM and PM snack and lunch. Meals are prepared by Glendale School District and delivered to the site daily in the morning.



First Aid supplies were observed in the classroom in a cabinet. According to Site Supervisor, Deidre Corwin medication is only administered to a child when accompanied with a doctor's note and is stored in the child’s classroom. Per Supervisor, Perla Leyvas, The school nurse office will be used by ill children. There is a napping cot available for an ill child. The restroom in school nurse office will used by ill children.

Medication: This facility provides Incidental Medical Services- IMS. Per Site Supervisor, Deidre Corwin currently there is no child enrolled to provide IMS. 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
REPORT CONTINUES ON NEXT PAGE 3 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: HORACE MANN EARLY EDUCATION AND EXTENDED L.P.
FACILITY NUMBER: 198017084
VISIT DATE: 01/12/2023
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
26
27
28
29
30
31
32
LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers with Program Director, Deidre Corwin 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, Perla Leyvas as far as children only use the outside water fountain for drinking from time to time and at the same time use water bottles to refill children water bottles, they will decide either to complete the water lead testing or provide drinking water to children by water bottles or water dispensers and request for a wavier.LPA referred Program Director to PIN 21-21-CCP and PIN 21-04-CCP.

LPA advised the Supervisor, Perla Leyvas 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 Supervisor, Perla Leyvas at 2:00 PM.


END OF REPORT PAGE 4 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 01/12/2023 01:40 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 01/12/2023 at 11:52 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HORACE MANN EARLY EDUCATION AND EXTENDED L.P.
FACILITY NUMBER: 198017084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.1(c)(2)
Napping Equipment-- Bedding shall be individually stored so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA and staff observations, the licensee did not comply with the section cited above and children used bedding comes into contact with other children used bedding which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
1
2
3
4
Per Supervisor, Perla Leyvas a training will be conducted with staff to ensure to store children bedding in a proper way that children used bedding does not come into contact with other bedding.
Type B
Section Cited
HSC
1597.16(a)(1)
(a) (1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.


This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's observation the licensee did not comply with the section cited above and not sure if the water Lead Testing was completed for this site or not which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
1
2
3
4
Per Program Supervisor, Perla Leyvas as far as children only use the outside water fountain for drinking from time to time and at the same time use water bottles to refill children water bottles, they will decide either to complete the water lead testing or provide drinking water to children by water bottles or water dispensers and request for a wavier.
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
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 01/12/2023 01:40 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 01/12/2023 at 12:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HORACE MANN EARLY EDUCATION AND EXTENDED L.P.
FACILITY NUMBER: 198017084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on children sign in and out sheet review, the licensee did not comply with the section cited above in 4 out of 19total count. During this inspection at 9:45 AM total of 19 children were present in the facility and 15 were signed in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
1
2
3
4
Per Program Supervisor, Perla Leyvas a notice will be send out to the parents to ensure to sign in/out their children daily and a copy of that letter will be emailed to LPA Eivazian by plan of correction due date 02/10/23.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023


LIC809 (FAS) - (06/04)
Page: 6 of 6