198019653-8-25-2020-33-CC-CGRN-BSTRY8-20200825132556

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019653
Report Date: 08/25/2020
Date Signed: 08/25/2020 01:26:03 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:	SIERRA MADRE UNITED METHODIST CHURCH-BRIDGE		FACILITY NUMBER:	198019653
ADMINISTRATOR:	STEPHANIE MCREYNOLDS		FACILITY TYPE:	850
ADDRESS:	695 W. SIERRA MADRE BLVD		TELEPHONE:	(626) 355-0629
CITY:	SIERRA MADRE	STATE: CA	ZIP CODE:	91024
CAPACITY:	68	CENSUS: 38	DATE:	08/25/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Lydia Nandakumaran		TIME COMPLETED:	01:30 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	An announced Case Management site inspection was conducted today by Licensing Program Analyst (LPA) Crystal Green to inspect and measure facility for capacity determination. Licensee is seeking to add a toddler option to the existing preschool license. Licensing staff met with Licensee, Lydia Nandakumaran, who guided analyst on a tour of the facility. This proposed Toddler Option program will operate from Monday through Friday 7:00 AM – 6:00 PM. At 10:45 AM, Licensing staff was guided through a tour of the proposed toddler option classrooms, the designated outdoor area, and the preschool program. The facility is currently operating and LPA observed in attendance a total of 38 children with 8 staff. The proposed toddler option classroom is Room 303, Room 304, Room 30 and the Nursery. LPA observed the toddler classrooms area to be physically separate from the Preschool classrooms. LPA also observed that each classroom has its own entrance to prevent crossing over between classrooms. LPA observed a fire extinguisher and functioning carbon monoxide detector in Room 304. LPA observed portable drinking water with disposable cups available in the classroom. There are age appropriate toys available for children in care. The Sierra house will be used for ill children to isolate if needed. Parent will provide snack and lunch for their children at this time due to COVID. At 10:55 AM, Licensing staff was guided through the proposed outdoor toddler space. There is adequate shade in outdoor play area. LPA observed the designated toddler area to be physically separate from the preschool yard. LPA observed the outdoor side area to be missing a barrier to preventing assess to the poles and water drainage area. Report Continues Page 1 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

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 2

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: SIERRA MADRE UNITED METHODIST CHURCH-BRIDGE	FACILITY NUMBER: 198019653
	VISIT DATE: 08/25/2020

NARRATIVE

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Based on measurements taken today, capacity for the proposed Toddler Option will be thirty-nine (39) toddlers and Preschool will remain at capacity of sixty-eight (68). Based on LPA observation the following corrections need to be corrected prior to obtaining the final approval for adding toddler option to the preschool license. Corrections are due by September 04, 2020:

• Licensee will need to install a barrier on the proposed toddler option outdoor side area.
• Licensee will need to obtain an update approved STD 850 (Fire Clearance) reflecting the new toddler’s requested capacity of 39
• Licensee will need to submit an updated LIC 500 (Personal Report) for the toddler option program.
• Licensee will need to request a waiver for the outdoor activity space due to requested toddler capacity.

Exit interview was conducted with Licensee. Appeal Rights were issued and discussed. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report Ends Page 2 of 2.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 854-5730
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2