198019784-10-6-2023-33-CC-TRAO-CWBRMN-20231005130901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019784
Report Date: 10/05/2023
Date Signed: 10/06/2023 07:37:29 AM

Document Has Been Signed on 10/06/2023 07:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ACADEMY AT PASADENA, THE		FACILITY NUMBER:	198019784
ADMINISTRATOR:	KARA LEWIS		FACILITY TYPE:	850
ADDRESS:	700 E GREEN ST		TELEPHONE:	(626) 578-7300
CITY:	PASADENA	STATE: CA	ZIP CODE:	91101
CAPACITY:	74	CENSUS: 33	DATE:	10/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Kara Lewis, Director		TIME COMPLETED:	01:10 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) Thelma Razo conducted an unannounced Required - 1 year inspection. LPA met with Director Kara Lewis and stated the purpose of the visit. LPA provided Director with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). A COVID 19 risk assessment was conducted prior to facility tour. Facility operation hours are from Monday to Friday from 8:00 AM to 5:30 PM. At 9:58 AM, LPA was provided a tour of the facility. Areas identified on the facility sketch was inspected. Children are signed in by parents on the assigned classrooms. Teacher-child ratios were observed. All children were observed by licensing staff to be always under visual supervision of a teacher. Yellow room - 10 children with 2 teachers Blue room - 11 children with 2 teachers Orange room - 12 children with 2 teachers Green room - vacant Page 1 of 4

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ACADEMY AT PASADENA, THE	FACILITY NUMBER: 198019784
	VISIT DATE: 10/05/2023

NARRATIVE

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Licensing staff observed the facility to be clean, safe, sanitary and in good repair. Individual storage space is available for each child; there are cubbies in each classroom. LPA observed cots located within each classroom. Toys were observed to be clean and safe. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and hand washing facilities are in safe and sanitary operating conditions. There are smoke detectors and working fire extinguishers located throughout the facility. There is drinking water accessible to the children in care via water dispenser and children bring their personal water bottles. Children do not have access to the kitchen and is being used as a staff lounge. Per Director the facility does not cook any meals for the children in the kitchen. The facility provides morning and afternoon snack, lunch is provided by parents.

All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

Licensing staff was guided through the outdoor activity space. All areas around or under high climbing equipment, and slides were observed to have cushion material
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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ACADEMY AT PASADENA, THE	FACILITY NUMBER: 198019784
	VISIT DATE: 10/05/2023

NARRATIVE

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to absorb a fall. LPA observed sufficient shaded area outdoors. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts.

Staff Records were reviewed during this inspection. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ACADEMY AT PASADENA, THE	FACILITY NUMBER: 198019784
	VISIT DATE: 10/05/2023

NARRATIVE

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post the results by January 1, 2023, and every 5 years after the date of the first testing. According to Director, lead testing was done in March 2022 and has passed the lead testing. Facility sketch and required forms LIC 9275, LIC9276 and LIC999 together with the lab reports were provided to LPA during this inspection.

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/inspection-process.

There was a deficiency cited under California Code of Regulations, Title 22. Notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted. Appeal Rights and report was reviewed with Director Kara Lewis.

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SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 10/06/2023 07:37 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ACADEMY AT PASADENA, THE	FACILITY NUMBER: 198019784
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the facility did not comply with the section cited above in 9 out of 9 staff did not have a current mandated reporter training which poses/posed a potential health, safety or personal rights risk to the children in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	Director stated that she will have the mandated reporter training completed and proof will be submitted to LPA Razo by plan of correction date of 10/20/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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