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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018562
Report Date: 11/20/2019
Date Signed: 11/20/2019 03:39:55 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:COVINA DEVELOPMENT CENTERFACILITY NUMBER:
198018562
ADMINISTRATOR:JEPPSON, PAULAFACILITY TYPE:
830
ADDRESS:437 W. SAN BERNARDINO RD. #111TELEPHONE:
(626) 967-7153
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY:33CENSUS: 24DATE:
11/20/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Sheena Yrma MinayaTIME COMPLETED:
04:00 PM
NARRATIVE
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An unannounced Case Management/Deficiencies Inspection was conducted by Licensing Program Analyst's (LPAs), Roxana Lopez and Cynthia Reyes. LPAs. Upon arrival LPAs took census of the Infant and Toddler classrooms. LPA's met with Site Supervisor Sheena Minaya ,who provided the personnel report and children's roster. Director Paula Jeppson arived to the facility minutes later. Days and Hours of operation are Monday thru Friday, 7:15 AM to 5:30 PM.

Based on LPA Cynthia Reyes observations from the initial inspection on 08/30/2019 and after the inspection and reviewing of files on 11/20/19, the following deficiencies listed on the attached LIC's 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Consultation was provided regarding no staff supervising the nap area on 08/30/2019. Staff member was immediately placed in the nap room. LPA informed them that if no nap room supervision was observed again a citation will be issued.

LPA's did a walk through with director and supervisor regarding the new playground being proposed. The placement of 4ft tall planters/ bushes along the walkway to divide the playground area was discussed.

LPA"S measured the existing infant/toddler classroom to assure that no square footage was taken when wall was added to divide the classroom into two classrooms.


SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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 5
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: COVINA DEVELOPMENT CENTER
FACILITY NUMBER: 198018562
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2019
Section Cited

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Alterations to Existing Buildings or New Facilities:
Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s). This requirement was not met as evidenced by:
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the facility did not report a wall added to divide a classroom to make it into two classrooms.This poses a potential risk to the health and safety of children in care.
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Type B
12/04/2019
Section Cited

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Current roster of children provided care in facility required. Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and
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telephone number of the child's physician. This roster shall be available to the licensing agency upon request. This requirement is not met as evidenced by no roster to review, This poses a potential health and safety risk to 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: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: COVINA DEVELOPMENT CENTER
FACILITY NUMBER: 198018562
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2019
Section Cited

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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.

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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: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: COVINA DEVELOPMENT CENTER
FACILITY NUMBER: 198018562
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/04/2019
Section Cited

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Outdoor Activity Space for Infants: Outdoor activity space shall be physically separate from space used by children in the child care center and school-age child care center components
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This requirement is not met as evidenced by: LPA observing infants walking through preschool play ground. This poses an immediate risk to the health and safety of children in care.
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Type A
12/04/2019
Section Cited

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Personnel Requirements: Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: request a transfer of a criminal record clearance as specified in Section 101170(f).
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This requirement was not met as S1 is not associated to facility. This poses an immediate risk to the health and safety of 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: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: COVINA DEVELOPMENT CENTER
FACILITY NUMBER: 198018562
VISIT DATE: 11/20/2019
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months.

Exit interview was conducted with Director Paula Jeppson and Site Supervisor Shenna Minaya, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5