198019510-2-18-2022-33-CC-FVAZ-CBRTLC-20220218134915

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019510
Report Date: 02/18/2022
Date Signed: 02/18/2022 01:49:24 PM

Document Has Been Signed on 02/18/2022 01:49 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:	AZUSA USD/CLIFFORD MURRAY ELEMENTARY CSPP		FACILITY NUMBER:	198019510
ADMINISTRATOR:	LESLIE FORD		FACILITY TYPE:	850
ADDRESS:	505 E. RENWICK RD.		TELEPHONE:	(626) 815-4724
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	60	CENSUS: 13	DATE:	02/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jenny Lee		TIME COMPLETED:	02:10 PM

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Licensing Program Analyst (LPA) Fabiola Vasquez conducted an unannounced annual inspection on 02/18/22 at 8:30 PM. LPA met with School Principal, Site Administrator Jeanette Florez. Shortly after Jenny Le arrived who guided analyst on a tour of the facility.

This is a preschool program which consists of two classrooms (3/4 and 5/6). Facility is only using room 3/4. Facility operates two sessions: Monday to Friday from 8:00 AM to 11:00 PM and 12:00PM to 3:00PM.

All areas identified on this report were inspected. Upon arrival LPA observed 13 children and 3 staff. Teacher-Child ratios were observed to be in accordance with Title 22 Regulations. All children were observed to be under visual supervision of a teacher at all times.

The following was observed during the tour of the facility:

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Children present were signed in. Disaster drill log was available. Last drill was conducted on 1/28/22. LPA observed required licensing documents posted on bulletin board in the hallway outside of the children's classrooms. LPA reviewed daily activity schedule which provides time for active play, quiet play, rest, eating and toileting. Facility disaster plan was observed and is complete.

Furniture and equipment were inspected for age appropriateness and good repair. LPA observed material and equipment are free of sharp, loose, or pointed parts. Telephone service, heating, lighting and ventilation were evaluated and are operable. There is at least one operable carbon monoxide detector. LPA observed a door leading to a children storage room. LPA advised the director to make the room inaccessible to children. Per director a latch will be installed and show proof to LPA.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

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: AZUSA USD/CLIFFORD MURRAY ELEMENTARY CSPP	FACILITY NUMBER: 198019510
	VISIT DATE: 02/18/2022

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Disinfectants, cleaning solutions and other items that are dangerous to children, were observed to be inaccessible in a high cabinet in the classroom. Medications are stored in the health office in a high shelf, inaccessible to children. Per director poisons are stored at the facility in the custodial room inaccessible to children Director understands that storage areas for poisons must be locked.

Menus were reviewed to ensure that they are being posted at least one week in advance and are visible to an authorized representative. The facility provides AM breakfast and PM provides Lunch.

Facility stores AM and PM snack in refrigerators in the elementary cafeteria. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment have cushioning material to absorb a fall.

LPA observed a round fish tank approximately 16 gallons inside the classroom during the visit. LPA attempted to move the tank was unable. LPA advised the site director to anchor the fish tank on to the shelve.

Per director there are no weapons or firearms on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption through the Azusa School District.

Principal- Site Director was missing proof of MMR, Child Abuse certificate, and first aide/ cpr.. Per director the original files are located at 245 W. 10th Street Azusa 91702.

Staff # 3 was missing the complete file. Per director the original files are located at 245 W. 10th Street Azusa 91702. LPA will review files on another day to the above location.

Children's records were reviewed for Child(C)# 2,C3,C4,C5,C6 and are admissions agreement. 245 W. 10th Street Azusa 91702. LPA will review files on another day to the above location.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

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: AZUSA USD/CLIFFORD MURRAY ELEMENTARY CSPP	FACILITY NUMBER: 198019510
	VISIT DATE: 02/18/2022

NARRATIVE

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LPA observed that facility is implementing COVID-19 precautions and procedures.

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.html

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 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/process.

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

Exit interview conducted and report was reviewed with the Jenny Le and Jeanette Florez.

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

LIC809 (FAS) - (06/04)

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