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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019481
Report Date: 07/08/2019
Date Signed: 07/08/2019 12:49:43 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:TOMORROWLAND ACADEMYFACILITY NUMBER:
198019481
ADMINISTRATOR:CLAIRE CHOUFACILITY TYPE:
850
ADDRESS:4126 N PECK RDTELEPHONE:
(626) 401-2489
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:98CENSUS: 40DATE:
07/08/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Director, Claire ChouTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) M. García conducted a Case Management Deficiencies Inspection to address citation observed. There were forty (40) children present in the facility at the time of inspection.

During a walk-through of the facility, LPA observed in room #3 that Staff #1 Teacher, Kathleen Kawato is not associated to the facility. Upon inspection of room #6 LPA observed that Staff #2 Lead Teacher, Te Zhao is also not associated to the facility. LPA called the Regional Office and determined through Licensing Information System (LIS) that Teacher Kathleen Kawato and Lead Teacher Te Zhao are both fingerprint cleared; however, they are not associated to the facility. Director and Teacher Kathleen Kawato both stated that Kathleen has been employed with the facility since December 2018. Director and Lead Teacher Te Zhao both stated that Te has been employed with the facility since April 2019. This poses an immediate risk to the health and safety of children in care. A civil penalty of $1,000.00 was assessed on this day.

Report Continues Page 1 of 2.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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 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: TOMORROWLAND ACADEMY
FACILITY NUMBER: 198019481
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/09/2019
Section Cited
CCR
101216(i)(2)
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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:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
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During LPAs inspection, LPA observed the LIC 9182 & LIC 508 forms complete for Staff #1 & Staff #2, per Director she will fax forms to Regional Office today 7/8/19, and will submit proof of fax to LPA on 7/9/2019 via email.
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This requirement is not met as evidenced by LPA called the Regional Office and determined through Licensing Information System (LIS) that Staff #1 & Staff #2 are both fingerprint cleared; however, they are not associated to the 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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
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: TOMORROWLAND ACADEMY
FACILITY NUMBER: 198019481
VISIT DATE: 07/08/2019
NARRATIVE
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The deficiency listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

*Note: Any Licensing reports indicating a Type A deficiency shall be posted immediately and for the next 30 days and copies provided of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months 1596.8595(c). Health & Safety Section 1596.859(a) shall be cited and a civil penalty of $100.00 for failure to provide copies to parents/guardians of children in care and newly enrolled children, and for failure to maintain written verification of receipt of licensing reports indicating a Type A violation (LIC 9224).



Exit interview was conducted with Director, Claire Chou including but not limited to Licensee Rights, Appeal Procedures and Agencies Consultative Role.

End Page 2 of 2.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3