198017598-11-13-2019-33-CC-AEIN-BHVS7T-20191113123805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017598
Report Date: 11/13/2019
Date Signed: 11/13/2019 12:38:13 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 CLINICS NESBITT EARLY HEAD START		FACILITY NUMBER:	198017598
ADMINISTRATOR:	CAROLINE AVEDIAN		FACILITY TYPE:	830
ADDRESS:	349 W. ALTADENA DR.		TELEPHONE:	(626) 794-7192
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	32	CENSUS: 21	DATE:	11/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Judy Cashell and Frances Hogan		TIME COMPLETED:	12:50 PM

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Licensing Program Analysts (LPA) Anomeh Eivazian and Lissette Gonzales conducted an unannounced Random inspection. LPAs met with Frances Hogan, Director who guided analysts on tour of the facility. During this inspection , Judy Cashell, Education Manager arrived to the facility. Facility is an Early Head Start serving infants from birth to ages 3. Section 101361 allows an infant to stay in the Early Head Start program until age 3 years old as long as there is documentation of the young child's developmental needs. This is an infant program which consists of 3 classrooms; RM 1 (0-18 months), RM 2 (18-36 months), and RM 3 (18-36 months). Also there is crib room (diaper changing area for toddlers and additional food preparation station). This facility is located on Altadena United Methodist Church . Facility operation hours are Monday to Friday from 7:30 AM to 4:30 PM.

All areas identified on the Facility Sketch were inspected. The following staff were present during this inspection: RM 1: 7 infants with 4 staff, RM 2: 7 infants/ toddlers with 4 staff, and RM 3: 7 infants/toddlers with 3 staff. The following was observed during the tour of facility:

PHYSICAL PLANT: Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director states that there is poison on the premises. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing facilities are safe, sanitary and are operating properly. All floors are clean and safe.

Napping equipment and bedding was inspected for good condition, appropriate storage and cleanliness. Storage for children's belongings was inspected. Linens are washed daily in the facility. There is Laundry equipment in the storage area, in the hallway. This area is inaccessible to children. Additional crib room will will be used by ill children. There is a napping cot and two cribs available for an ill child. The staff restroom will used by ill children.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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 CLINICS NESBITT EARLY HEAD START	FACILITY NUMBER: 198017598
	VISIT DATE: 11/13/2019

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The program use the church kitchen. 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. Also, LPAs observed two refrigerators, a food warmer and additional food preparing area in the crib room. Trash cans used to discard food have tight fitting lids. Drinking water readily available both indoors and outdoors.The facility was observed to be free of flies, other insects and rodents.

INFANT PROGRAM (in addition to general compliance)
Infant changing tables have a padded surface no less than one inch thick and are covered with washable vinyl or plastic and have raised sides at least three inches high. Toys were observed to be clean and safe. Infant napping equipment meets the requirements of 101439.1 (a) - (f).

The facility is in compliance with the staff-infant ratios. Infant Needs and Services Plan are on file for each infant that meets the requirements of 101419.2 (a)-(b) and 101419.3 (a). An individual feeding plan for each infant meets the requirements of 101427(b)(1)-(5). Teachers present have proof of the required infant units on file and meet the qualification requirements of 101416.2 (a), (b), (c) and (g). Sign in and out sheets were reviewed.

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 health screening for each staff present are on file and were reviewed.

In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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: PACIFIC CLINICS NESBITT EARLY HEAD START	FACILITY NUMBER: 198017598
	VISIT DATE: 11/13/2019

NARRATIVE

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Staff and Children’s Records were reviewed for completeness; Inspection of required forms was made. LPAs issued the Confidential Names List (LIC 811) to the director during this inspection. The Confidential Names List documents the staff and children’s files that were reviewed during this inspection.

LPAs advised the Director to access forms, regulations, quarterly updates and provider information notices (PINs) on the Child Care Licensing website at: www.ccld.ca.gov. LPAs reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.

During this inspection the comments of current facility license was explained. License limitation was reviewed and discussed with Judy Cashell, Education Manager.

There were no deficiencies cited during today’s inspection.

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 Judy Cashell, Education Manager and Frances Hogan, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

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 CLINICS NESBITT EARLY HEAD START	FACILITY NUMBER: 198017598
	VISIT DATE: 11/13/2019

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H&S 1596.8662: Commencing January 1, 2018 all the licensed providers, applicants, directors and employees are required to complete training as specified on the mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Mandated reporter training certificates were available on staff files.

Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 10/15/2019.

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. The facility provides breakfast, lunch, PM snack, and formula.

Food is brought in by vendor to the church's kitchen where there is a refrigerator and food warmer dedicated to the Early Head Program. Staff then bring meals in for infants and toddlers. Food, formula, and diapers are provided for infants and toddlers. Mothers may provide breast milk or come in to nurse the infant. Breast milk brought from home is labeled with the infant's name, date, and time brought in. Staff will bring the breast milk in (bottled) and warm it up in a bottle warmer. At this time, no infant with breast milk.

The facility shall ensure that each infant is never left unattended, and is under the direct visual supervision of a staff person at all times.

Medication: This facility provides Incidental Medical Services – IMS. However, currently there is no children with Incidental Medical Services. 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 02/27/17.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 11/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019

LIC809 (FAS) - (06/04)

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