<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018309
Report Date: 07/25/2022
Date Signed: 07/25/2022 02:18:02 PM


Document Has Been Signed on 07/25/2022 02:18 PM - 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:SOUTH HILLS ACADEMYFACILITY NUMBER:
198018309
ADMINISTRATOR:MICHELLE CLAYTONFACILITY TYPE:
850
ADDRESS:1600 E. FRANCISQUITO AVE.TELEPHONE:
(626) 919-2000
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:120CENSUS: 46DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Michelle Clayton, DirectorTIME COMPLETED:
02:30 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
On 7/25/2022, Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Required - 1 year inspection. LPA met with Director Michelle Clayton and stated the purpose of the visit. A COVID-19 risk assessment was made prior to entry to the facility. LPA provided Director with a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a preschool program which consists of 6 classrooms. Business hours are from Monday to Friday, 6:30 AM to 6:00 PM.
LPA was guided to a facility tour by Director at 10:52AM.

All areas identified on the Facility Sketch were inspected to include 6 classrooms and outdoor play area. The classrooms are as follows:
  • Room 125 Growing Tree (4 yo) - 9 children with Staff #1 and #2
  • Room 126 Busy Dinosaur (4 yo) - 9 children with Staff #3
  • Room 127 Sunshine (4 yo) - 8 children with Staff #4 and #5
  • Room 128 Rainbow (2 yo) - 8 children with Staff #6 and #7
  • Room 129 Angel Fish (3 yo) - 6 children with Staff #8 and #9
  • Room 130 Super Heroes (3 yo) - 6 children with Staff #10

The facility was observed to be within the license capacity and limitations.

Page 1 of 4
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
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: 07/25/2022
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
26
27
28
29
30
31
32
The following were observed during the tour of the facility:
Furniture and equipment were inspected for age appropriateness and good repair, telephone service, central air and heating, lighting and ventilation were evaluated. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. Per staff, there were no firearms stored on the premises and no pools or bodies of water. Children have their own cubby to store their belongings. Children bring their own blankets and sheets and have them sent home on Fridays. Per Director, the isolation area is in the office in an enclosed area. 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 the classroom. First Aid supplies were observed in the classroom.
Disinfectants, cleaning solutions, and other items that are dangerous to children were inaccessible. Director states that there are no poisons stored at the facility. Carbon monoxide detector was tested and was operable.

Facility provides morning snacks and afternoon snacks. Menu was observed to be posted one week in advance.

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. Availability of outdoor drinking water was observed - children bring their own water bottle with facility providing refills. LPA advised that no children shall be left without the supervision of a teacher at any time.



Page 2 of 4
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
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: 07/25/2022
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
26
27
28
29
30
31
32
All individuals present have obtained a criminal record clearance or criminal record exemption. The review of Staff records was documented on the LIC 859. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Staff present have proof against TB, measles, pertussis, and influenza. All staff have been given on-the-job training on sanitation principles, housekeeping, including universal health precautions.
Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in.

According to Director, there are currently no children on medication. 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 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



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

Page 3 of 4
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
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
VISIT DATE: 07/25/2022
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
26
27
28
29
30
31
32
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/tion-process

There were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Michelle Clayton.

Page 4 of 4

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4