198020488-2-11-2021-33-CC-LGOZ-BY5QS9-20210211112511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020488
Report Date: 02/11/2021
Date Signed: 02/11/2021 11:25:21 AM

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:	DE ANZA ELEMENTARY EARLY HEAD START - INFANT		FACILITY NUMBER:	198020488
ADMINISTRATOR:	REBECCA JIMENEZ BARLOW		FACILITY TYPE:	830
ADDRESS:	12820 EAST BESS ST.		TELEPHONE:	(626) 962-3311
CITY:	BALDWIN PARK	STATE: CA	ZIP CODE:	91706
CAPACITY:	9	CENSUS: 0	DATE:	02/11/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Rebecca Jimenez-Barlow		TIME COMPLETED:	11:40 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	On February 11, 2021 at 9:03a.m., Licensing Program Analyst (LPA) Lissete Gonzalez, conducted an announced Pre-Licensing visit to inspect and measure this facility for capacity determination. LPA met with Rebecca Jimenez-Barlow, applicant, who provided LPAs with an indoor and outdoor tour of the facility. The applicant is requesting a capacity of 9 Infants for an Early Head Start Program located on De Anza Elementary School grounds. There are two (2) existing licensed Preschool components located on site. Preschool license number 198006401 and license number 191500336. The entrance to the facility is located on the corner of Bess Avenue Street and Barnes Avenue. This is a proposed Infant Program which consists of one classroom, De Anza #3. This program will serve children ages 0 to 24 months. The Early Head Start Infant program will operate a full day session from 8:00a.m. to 3:00p.m. from Monday to Friday. All areas identified on the facility sketch were toured both indoors and outdoors; measurements were taken. Sign-In and Sign-Out books are located at the entrance of classroom; health checks will be conducted prior to parents signing infants in on a daily basis. There is accessible drinking water readily available in the classroom via a portable water jug with disposable cups. Furniture and equipment were inspected for age appropriateness and good repair. The infant changing table has a vinyl padded surface no less than two inches thick and has raised sides at least three inches high. The changing table was observed to be within arm’s reach of a sink. Toys were observed to be clean and safe. Telephone service, heating, lighting and ventilation were evaluated. Infants have their own cubby to store their belongings. REPORT CONTINUES ON NEXT PAGE: 1 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

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: DE ANZA ELEMENTARY EARLY HEAD START - INFANT	FACILITY NUMBER: 198020488
	VISIT DATE: 02/11/2021

NARRATIVE

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LPA observed a total of 3 infant cribs including an emergency crib and a total of 10 mats. LPA observed a partition separating the infant crib napping area from the remainder of the classroom. Linens will be taken home weekly on Fridays by child’s authorized representative for laundering and washed on-site as needed. Infants have age appropriate feeding chairs/tables. LPAs advised Applicant to ensure that infants are being visually supervised during feeding times. LPA observed the facility has a carbon monoxide detector, smoke detector, and a serviced fire extinguisher.

LPA did not observe any baby walkers, baby bouncers or baby saucers at the facility. LPA discussed individual Feeding Plans are to be on file for each infant. LPA advised, Infant Needs and Services Plan are to be on file for each infant. Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file. Teachers present must have proof of the required infant units on file and meet the qualification requirements. Disinfectants, cleaning solutions, and other items that are dangerous to children, will be inaccessible to infants and stored in a locked cabinet.

This program will provide breakfast, lunch, an AM snack and a PM snack. Food will be prepared by the District cafeteria. Infants will be provided with formula by the facility. A monthly snack menu is available and posted. LPA advised the Applicant to label and date all food, dishes and bottles that are brought from home for proper storage.
All kitchen areas/food preparation areas and food storage areas were observed to be clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects and rodents.

The outdoor playground equipment for safety. At 9:41a.m., LPA observed six (6) safety poles in the playground that do not have a protective cushion barrier installed. LPA observed the outdoor play area to have cushioned padding to absorb a fall. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is adequate shade in the play yard. Availability of outdoor drinking water was observed via a water jug with disposable cups. There are no bodies of water, weapons, or firearms on the premises.

Applicant states that any life saving medication will be stored in the classroom in a backpack that is inaccessible to children in care. A First Aid kit is available in the classroom and was observed to contain the
REPORT CONTINUES ON NEXT PAGE: 2 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: DE ANZA ELEMENTARY EARLY HEAD START - INFANT	FACILITY NUMBER: 198020488
	VISIT DATE: 02/11/2021

NARRATIVE

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required first-aid supplies.

The Teacher’s office area will be used as an ill/isolation area. Ill children will use the staff restroom located in the infant room if needed. A mat is available for an ill infant to rest. This room was observed to be conducive for children's use at this time.

Infant Care: LPA provided applicant with a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations In Effect. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS.

Items discussed during this visit:
Licensing does not tolerate the following: Refused Entry to a Facility or Any Part of a Facility is a
violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both.
Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.
Current Children’s Roster: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR must be present. Per applicant, Teacher’s will have a copy of their teacher permit available.
Designated Staff: The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence must be on file.
Qualifications: Educational background, training, and/or experience for each staff present must be
available for review. Per applicant, Teacher’s will have a copy of their teacher permit available.

Children’s Records: must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume
REPORT CONTINUES ON NEXT PAGE: 3 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: DE ANZA ELEMENTARY EARLY HEAD START - INFANT	FACILITY NUMBER: 198020488
	VISIT DATE: 02/11/2021

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responsibility for the child if the authorized representative cannot be reached when necessary.
Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or
volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and
measles.

Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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.

AB1207: The following was discussed: As of January 1, 2018, Health & Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. New employees shall have 90 days from date of employment to complete training as required. The training may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules at: http://www.mandatedreporterca.com/.

LPAs advised the Applicant to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: Parent’s Rights Poster (with complaint hotline) was provided to the Applicant during this inspection. LPA provided the following documents about SIDS: A Child Care Provider’s Guide to Safe Sleep from the American Academy of Pediatrics, Helping You to Reduce the Risk of SIDS, Never Shake a Baby, and Safe Sleeping practices.

Liability insurance was also discussed. The applicant is seeking to provide care for 9 infant children. A fire clearance was granted on 02/28/2020.
Based on the LPA’s observation, the following corrections need to be corrected. Corrections are due by 02/25/2021:
· Installation of protective cushion barriers to the six (6) poles located on the infant playground.

Exit interview conducted with Rebecca Jimenez-Barlow. Appeal Rights were given and explained.
END OF REPORT: PAGE 4 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4