198017900-10-4-2019-33-CC-CRES-BGN3QZ-20191004182759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017900
Report Date: 10/04/2019
Date Signed: 10/04/2019 06:28:06 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:	AMERICAN FUTURE		FACILITY NUMBER:	198017900
ADMINISTRATOR:	DONG HUA		FACILITY TYPE:	840
ADDRESS:	1172 E. CYPRESS		TELEPHONE:	(626) 332-0532
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	42	CENSUS: 20	DATE:	10/04/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	04:16 PM
MET WITH:	Florence Banda		TIME COMPLETED:	06:30 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	Annual Random Site inspection was conducted by Licensing Program Analysts, (LPAs) Cynthia Reyes and Alanna Gontarek, who met with director, Florence Banda, who guided analysts on a complete tour of the facility. Their are 2 classrooms for the school-age program. M-F 6 AM-6 PM 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. Napping equipment and bedding were inspected. Storage for children's belongings and an isolation area with a sink and 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. Carbon monoxide detector in place. 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. Breakfast, AM/PM 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. Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met. Report continues to next page

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

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: AMERICAN FUTURE	FACILITY NUMBER: 198017900
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/11/2019 Section Cited	1 2 3 4 5 6 7	Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. This requirement is not met as evidenced by no current copy of the Personnel Report (LIC 500). This poses a potential health and safety risk to the children in care.
Type B 10/11/2019 Section Cited	1 2 3 4 5 6 7	Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times. The requirement is not met as evidenced by one of the school-age bathroom toilet is broken and outlet covers missing in the class rooms. This poses a potential health and safety risk to the children in care.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: AMERICAN FUTURE	FACILITY NUMBER: 198017900
	VISIT DATE: 10/04/2019

NARRATIVE

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Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, Director Qualifications and verification of CPR/First Aid and health preventive practices documentation. Review of required forms was made.

A review of all facility staff or other individuals who require caregiver background checks was conducted on this date to determine if they have received criminal record and child abuse index clearances or exemptions and/or have provided proof of submission of finger prints to DOJ, FBI and CAIC.

Incidental Medical Services - (IMS) was discussed. For IMS information see Evaluator Manual - Regulation and 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 Per licensee, IMS is not provided.

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

After a complete inspection of the facility, Deficiencies are cited on attached 809D. according to California Code of Regulations Title 22 Division 12 during today's visit.

Consultation was conducted on this date. (Shade over the large apparatus, Carbon Monoxide in the separate school age building, Staff rest room fix toilet paper hanger as well as paper towels), and need supplies of toilet seat covers)

An exit interview was conducted, copy of report given. Notice of Site Visit form was provided and explained. Appeals Rights provided and explained.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

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