198019481-8-1-2019-33-CC-MGAA-BEMQBV-20190801120210

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019481
Report Date: 08/01/2019
Date Signed: 08/01/2019 12:02:20 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 ACADEMY		FACILITY NUMBER:	198019481
ADMINISTRATOR:	CLAIRE CHOU		FACILITY TYPE:	850
ADDRESS:	4126 N PECK RD		TELEPHONE:	(626) 401-2489
CITY:	EL MONTE	STATE: CA	ZIP CODE:	91732
CAPACITY:	98	CENSUS: 18	DATE:	08/01/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Claire Chou, Director		TIME COMPLETED:	11:50 AM

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	An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) M. García to address an Unusual Incident Report that was received in the licensing office on 07/08/2019. LPA met with Office Manager Lois Chen who guided LPA on a tour of facility of both indoors and outdoors. On 07/08/2019, child #1 is a four-year-old who became nauseous and then was not responding during napping time. Staff #1 & Staff #2 assisted child #1 while Staff #3 contacted 911. Child #1 was transported by the Ambulance to the hospital, Staff #3 accompany child #1. First Aid was administered and the parent of child #1 was notified. Child returned to school on 07/11/2019. Based on all information obtained on this date, and interviews conducted with Child #1, Staff #1, Staff #2, Staff #3 and Staff #4, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

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: TOMORROWLAND ACADEMY	FACILITY NUMBER: 198019481
	VISIT DATE: 08/01/2019

NARRATIVE

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The following was discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

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: TOMORROWLAND ACADEMY	FACILITY NUMBER: 198019481
	VISIT DATE: 08/01/2019

NARRATIVE

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LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

These forms may also be downloaded from our website: www.ccld.ca.gov

There were no deficiencies cited during today's visit.

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

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019

LIC809 (FAS) - (06/04)

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