198020493-1-29-2020-33-CC-CRES-BLAQNC-20200129111855

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020493
Report Date: 01/29/2020
Date Signed: 01/29/2020 11:19:03 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:	AZUSA UNIFIED SCHOOL DISTRICT/HENRY DALTON		FACILITY NUMBER:	198020493
ADMINISTRATOR:	LESLIE FORD		FACILITY TYPE:	850
ADDRESS:	500 E. 10TH ST		TELEPHONE:	(626) 815-4727
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	60	CENSUS: 0	DATE:	01/29/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Laura Clarke, Leslie Ford, Jenny Le		TIME COMPLETED:	11:20 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	Cynthia Reyes and Jennifer Anguiano, Licensing Program Analysts (LPAs) conducted an announced pre-licensing inspection. LPA met with applicant ECE Director, Leslie Ford and Jenny Le. The proposed California State Preschool program (CSPP) will operate on the Henry Dalton School site and will serve children ages three and four (3 & 4) years old. There is one classroom (Room 20) to be used for the preschool program. Licensing staff inspected and measured the classrooms. Per measurements the classroom is at a capacity of 29. The preschool will have two (2) half day sessions, 8-11 AM and 12-3 PM and will follow the Elementary year round school calendar. Sign In/Out sheets for each child will be located in the classroom. Parents and students will enter through the gate off the street North Pasadena next to elementary school entrance. The Principal (Laura Clarke) office is located in the school main office. The Isolation area for ill children is located in the health office located in the school main office where there is a napping cot available and rest room. The staff restroom is located in the classroom however staff will have access to staff lounge and secondary rest room located in the school main office. Applicant shall ensure that food is age appropriate and follows Federal Food Guidelines. Food will be prepared by an outside vender (the District) and served in the class room family style. Facility will provide Breakfast for the AM session and Lunch for the PM session. There is age-appropriate furniture and equipment observed in the classrooms which appear to be in good condition. The room has central heating and air-conditioning. Cubbies are available for each child's belonging. The classrooms has a water fountain for children to drink freely.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

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 UNIFIED SCHOOL DISTRICT/HENRY DALTON	FACILITY NUMBER: 198020493
	VISIT DATE: 01/29/2020

NARRATIVE

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The classroom has two toilets and one sink available for use. Per Leslie Ford, updates will be completed in order to comply with licensing. There is dispensable soap and paper towels in the bathroom that are located in the classroom. Children will not nap in the half day program. Children's belongings are not to come in contact with other children's belongings.

Licensee was advised containers used to discard food have tight fitting lids. Cleaning compounds were observed not to be accessible in the classrooms. The applicant does understand that poisons need to be locked with a key or combination lock. There is a small First aid kit available in the classroom. The applicant states that there are no bodies of water on the premises and none were observed during this inspections.

The outdoor activity area was inspected and measured for capacity determination. Outdoor play yard was measured for a capacity of 191. Outdoor play yard is surrounded by a fence to separate the preschool from the older Elementary school children on site. Playground equipment is in safe condition, free of sharp, lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. The areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is age appropriate toys and play equipment, and are in good condition. There is shade available by trees, over hang and the building, jug of water and cups are to be available for children as needed.

Medication: This facility plans to provide Incidental Medical Services. A medication log is kept on file in the office to track use of medication by children. IMS plan will be submitted.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

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 UNIFIED SCHOOL DISTRICT/HENRY DALTON	FACILITY NUMBER: 198020493
	VISIT DATE: 01/29/2020

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Reminder: Items to be posted are: Facility License, Emergency Disaster Plan, Earthquake Preparedness Check list, Parents Rights Poster, Personal Rights, Child Car Seat Laws Menus, Activity Schedule, Any Waivers Granted if applies.

The following items must be corrected within seven (07) days prior to issuance of a license:
Per Leslie Ford, the carpet in the room will be replaced as well as sink will be added and modernizing the entire classroom. Leslie ford stated she will submit a plan of operation regarding updated to the class room.

LPAs proposes a provisional license to be given until a final review of the facility which will be conducted to approve for a regular license. The school year is scheduled to open in August 2020.

Applicant requested a capacity of 60, however room 20 only allows per measurements for a capacity of 29. A fire clearance has been approved for capacity of 60 and will be updated to reflect a capacity approval of 29 and will be placed on file. All documents in file were reviewed. Based on measurements and number of sinks, toilets/urinals, the maximum number allowed will be 29 preschool children.

Licensure is contingent upon completion of the above corrections.

Check our website at: www.ccld.ca.gov. for regulations and quarterly updates.

Exit interview conducted with Applicant ECE Director, Leslie Ford and a copy of report was given. Appeal rights were issued and discussed.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020

LIC809 (FAS) - (06/04)

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