198019784-8-15-2019-33-CC-JDOY-BF3V7M-20190815161122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019784
Report Date: 08/15/2019
Date Signed: 08/15/2019 04:11:29 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:	CHALK OF PASADENA LLC		FACILITY NUMBER:	198019784
ADMINISTRATOR:	SONDRA AHEARN		FACILITY TYPE:	850
ADDRESS:	700 E GREEN ST		TELEPHONE:	(626) 578-7300
CITY:	PASADENA	STATE: CA	ZIP CODE:	91101
CAPACITY:	74	CENSUS: 35	DATE:	08/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Kara Lewis		TIME COMPLETED:	04:25 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	Licensing Program Analyst (LPA) Justin Dorsey and conducted an unannounced Annual Random Inspection. LPA met with Kara Lewis, Director, who guided LPA on a tour of the facility. LPA inspected all areas identified on the Facility Sketch. The following staff were observed in each classroom during this visit: Green Classroom: Staff #1, Staff #2 and Staff #3 with 6 children; Orange Classroom: Staff #4 and Staff #5 with 10 children; Yellow Classroom: Staff #6 and Staff #7 with 8 children; Blue Classroom: Staff #8, Staff #9 and Staff #10 with 11 children. Students have access to the classrooms, restrooms, outdoor play area and My Gym (an additional area for children's outdoor activities). Children are signed in by parents at their assigned classrooms. The facility does not provide transportation. Furniture and equipment are safe and in good repair. There is telephone service, heating, lighting and ventilation available at the facility. The Directors office is used as an isolation area, the staff restroom has been designated for the use of ill children. Drinking water is available indoors and outdoors. Restrooms used were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. The kitchen, which the students don't have access to is used as a staff lounge. Per Director the facility does not cook any meals for the children in the kitchen. The facility provides am and pm snack, lunch is provided by parents. The facility also offers a online service through Citizens Sprouts where parents can purchase lunches for their children. Containers used to discard food have tight fitting lids at this time. Snack menus were posted in the classrooms. Snacks were reviewed for availability, quantity and appropriateness to children in care. Poisons are locked in a cabinet. Cleaning compounds and sharp items are inaccessible.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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: CHALK OF PASADENA LLC	FACILITY NUMBER: 198019784
	VISIT DATE: 08/15/2019

NARRATIVE

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The outdoor area and My Gym include areas with play equipment for the children with adequate cushioning. Both areas use shade sails for shade. Both play areas are fully fenced. A review of records was conducted for staff and participants. LPA observed that staff have current First Aid and CPR (Expires 01/2021). Staff has met all immunization requirements. Ratios were observed to be in compliance. First Aid supplies are available. Disaster drills are documented and all posting requirements have been met.

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.htm

LPA advised how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. Also, discussed new requirements for providers, including mandate reporting training for staff which can be found at: http:/www.mandatedreporterca.com/training /training.htm. This is a new regulatory requirement beginning January 2018. According to staff, training has been completed through Community Care Licensing. Please review all elements outlined in AB 1207- Mandated Reporting Training.

No deficiencies were cited in accordance with California Code of Regulations Title 22. 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 reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director Kara Lewis, Notice of Site Visit and Appeal Rights were given.

SUPERVISOR'S NAME: Adriana Hernandez	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

LIC809 (FAS) - (06/04)

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