198017844-5-17-2019-33-CC-AALN-BC9UE9-20190517153046

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017844
Report Date: 05/17/2019
Date Signed: 05/17/2019 03:30:51 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:	PASADENA PRESCHOOL ACADEMY		FACILITY NUMBER:	198017844
ADMINISTRATOR:	GUNASEKARA, HISSANKA		FACILITY TYPE:	830
ADDRESS:	2631 WOODLYN		TELEPHONE:	(626) 794-4614
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	32	CENSUS: 26	DATE:	05/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:31 PM
MET WITH:	Lisa Telles		TIME COMPLETED:	03:45 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) Ariel Cazares conducted an unannounced annual/random inspection on this date. LPA met with Assistant Director Lisa Telles. LPA was guided on a tour of the facility. LPA observed a total of 26 children and 6 staff. Facility was in compliance with staff-child ratios. The director arrived shortly after. The facility is an infant program that consists of 2 classrooms. There is a preschool program on the property separately licensed under facility #198017845. LPA toured the areas according to the facility sketch on file. Per director, no alterations have been made. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Clean linens are provided daily for this program. Napping equipment (cots and cribs) were observed. The infant classroom has a separate napping area with cribs. The toddler classroom has cots available to them in their classroom. The children's restrooms and diaper changing areas were inspected. LPA observed them to be clean and supplies available for use by children. There is available drinking water in the classrooms for children in form of water jug and disposable cups for children who drink water. Food and snacks are provided to children or brought by parents based on preference. The current Needs and Service Plan is located in the classrooms. Kitchen counter tops were clean and free of clutter or standing food. Cleaning compounds are inaccessible to children. Children's items, such as bottles and food, were properly labeled and stored. First aid supplies are in classrooms and office.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

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: PASADENA PRESCHOOL ACADEMY	FACILITY NUMBER: 198017844
	VISIT DATE: 05/17/2019

NARRATIVE

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There are 2 playgrounds for this program. LPA inspected the outdoor equipment for safety, cushioning material, good repair and age appropriateness. Required shade and fencing were observed. Outdoor drinking water is provided in form of water jug and disposable cups brought out from inside.

LPA also reviewed staff criminal record clearances, children and staff records, and sign in and out sheets. Files and documentation were complete. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. LPA provided director with a copy of the Safe Sleep Concepts for review.

The isolation area is located in the office where a mat can be laid out. The staff restroom can be used for an ill child. Children's medication is kept in a box that is locked in the office and appropriate documentation is on file.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

LPA did not observe any violations. No deficiencies were cited on this date. Exit interview conducted with Director Arlene Madrid. A copy of this report and appeal rights were provided and explained.

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.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel Almazan	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019

LIC809 (FAS) - (06/04)

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