198017640-8-24-2022-33-CC-BBAT-CHLPQ4-20220824113030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017640
Report Date: 08/24/2022
Date Signed: 08/24/2022 11:30:35 AM

Document Has Been Signed on 08/24/2022 11:30 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:	OPTIONS-STATE PRESCHOOL-AZUSA HIGH		FACILITY NUMBER:	198017640
ADMINISTRATOR:	DEBORAH SLOBOJAN		FACILITY TYPE:	850
ADDRESS:	240 N. CERRITOS AVENUE		TELEPHONE:	(626) 854-3449
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	48	CENSUS: 11	DATE:	08/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:			TIME COMPLETED:	11:45 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 unannounced Required Annual site visit was conducted by Licensing Program Analyst (LPA), Bardo Baluyot who met with Teacher, Liza Cantabrana. LPA conducted a COVID risk self-assessment upon entry. LPA conducted a complete tour of the facility. Program currently operates a morning session from 8am to 12pm in Classroom A . Per staff, due to low enrollment, Classroom B and afternoon sessions are not in use at this time. Rooms identified on facility sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet were inspected. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor drinking water was observed. Smoke/Carbon Monoxide Detectors were inspected and found to be operable. First Aid supplies were inventoried. Class roster was available for review. Sign in/out sheets were reviewed and found to be complete. Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness. A review of cleaning and food supply storage areas was made.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

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: OPTIONS-STATE PRESCHOOL-AZUSA HIGH	FACILITY NUMBER: 198017640
	VISIT DATE: 08/24/2022

NARRATIVE

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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 Section 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. Child's medication was reviewed by LPA and found to be within expiration date (9/22) and included physician's info/parent authorization.

After a complete inspection of the facility, no deficiencies were cited during today's visit according to California Code of Regulations Title 22 Division 12.

No children or staff files were reviewed during today's visit. Staff and children's files are stored at the Options State Preschool's main office located at: 18455 E. Railroad St. City of Industry, CA 91748. Tel # (626) 854-3449

Exit interview conducted and report was reviewed with Teacher, Liza Cantabrana.

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.

INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

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/inspection-process.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC809 (FAS) - (06/04)

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