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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018309
Report Date: 03/03/2020
Date Signed: 03/03/2020 01:06:34 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:SOUTH HILLS ACADEMYFACILITY NUMBER:
198018309
ADMINISTRATOR:CARLOS, KATHRYNFACILITY TYPE:
850
ADDRESS:1600 E. FRANCISQUITO AVE.TELEPHONE:
(626) 919-2000
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:120CENSUS: 53DATE:
03/03/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director Michelle Clayton TIME COMPLETED:
01:10 PM
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At 8:30 am Licensing Program Analyst (LPA) Roxana Lopez and Cynthia Reyes conducted an unannounced required annual inspection at the above facility. LPA's met with Michelle Clayton, Director, who guided analyst on a tour of the facility. This is a preschool program which is located on a private elementary campus and is physically separated from the elementary school. This program consists of 5 classrooms. Facility operation hours are Monday to Friday from 6:30 AM to 6:00 PM.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Room 1: Two teachers with 11 children; Room 2: Two Teachers with 11 children; Room 3: One teacher with 12 children; Room 4: One teacher with 10 children and Room 5: One Teacher with 9 children. The following was observed during the tour of the facility:

PHYSICAL PLANT



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. Linens are brought in by parents and taken home on Friday to be washed. Napping equipment (cots) were observed in each classroom. Per director, the isolation area is located in the office. 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 classrooms.

Disinfectants, cleaning solutions and other items that are dangerous to children, were accessible to children. LPA’s observed a powder to cover up vomit in classroom 3 and air freshener, cooking spray, oil and knives in classroom 5. Director Michelle Clayton states that there are no poisons in the facility.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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 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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198018309
VISIT DATE: 03/03/2020
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The facility provides AM and PM snack. Snacks were reviewed for availability, quantity and appropriateness to children in care. Preschoolers bring their own food and or have the option of hot lunches which is prepared at the elementary school. Menus are posted one month in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. During the inspection of the kitchen area at around 10:45 am LPA Lopez observed an infant in the pantry area sitting on a high chair eating cherrios and watching a movie. Per Chef the infant is his daughter. Even though the facility is not licensed for infant care a violation of this infant's personal rights was observed due to the infant being in the pantry area. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. 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, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed.

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.

Children’s Records were reviewed for completeness; Inspection of required forms was made. LPA issued a copy of the Children’s Confidential Name List (LIC 811) to the director during this inspection. 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.

LPA also issued the List of Staff Confidential Names List (LIC 811) to the licensee during this inspection. The LIC 811 documents the staff and children’s files that were reviewed during this inspection.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 2/19/2020

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198018309
VISIT DATE: 03/03/2020
NARRATIVE
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First Aid supplies were observed in the classroom in a backpack. According to Director, medication is only administered to a child when accompanied with a doctor's note and is stored in the office. Per Director there are no children currently enrolled with medication,

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 advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

The following deficiencies listed on the attached deficiencies page 809 D are being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee/Director.

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 Michelle Clayton, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 3 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: SOUTH HILLS ACADEMY
FACILITY NUMBER: 198018309
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/03/2020
Section Cited

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101223- Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by LPA observing an infant in the pantry area located in the kitchen, sitting on a high chair
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 eating cherrios and watching a movie.Per chef the infant is his daughter. Even though the facility is not licensed for infant care a violation of this infant's personal rights was observed due to the infant being in the pantry area. This poses an immediate risk to the health and safety of the children in care.
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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: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4