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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191231022
Report Date: 10/29/2024
Date Signed: 10/29/2024 10:33:29 AM

Document Has Been Signed on 10/29/2024 10:33 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:HAMILTON PRESCHOOLFACILITY NUMBER:
191231022
ADMINISTRATOR/
DIRECTOR:
PATRICIA GUZMANFACILITY TYPE:
850
ADDRESS:2089 ROSA VILLA ST. RM. 102TELEPHONE:
(626) 793-0678
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 8DATE:
10/29/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Antoineta Murrillo Smith - Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analysts (LPAs) Nolan Tcheng and Mariah Aguirre conducted an unannounced Annual inspection. Upon arrival at 8:45am, LPAs met with Lead Teacher Antoineta Murrilo. At 9am, LPAs were led on a tour of the facility. This is a Preschool program which consists of 1 classroom. Program takes place in Room A102 on Hamilton Elementary School campus and is part of the Pasadena Unified School District. This is a halfday program with an AM class and PM class. Per licensee, there are currently 13 enrolled in the program. Hours of operation for this facility are 8:15-11:15am for AM group, and 12:15-3:15pm for PM group.

Licensing staff observed all required forms/publications to be posted in the classroom. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request.

At 9am, LPAs entered and inspected Room A102: There were 8 children with 2 staff members. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. There is no nap time at the facility due to it being a half day program.

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. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water was readily available indoors. At this time, the Nurse's Office is used as an isolation area. A small bed is available for an ill child to rest on. First Aid supplies are available and complete. Facility has a functioning carbon monoxide detector that meets statutory requirements. The building for the school has an in line fire alarm and sprinkler system. Director states there are no weapons, firearms, or bodies of water on the premises

REPORT CONTINUES PAGE 1 of 3

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: HAMILTON PRESCHOOL
FACILITY NUMBER: 191231022
VISIT DATE: 10/29/2024
NARRATIVE
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At 9:15am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 12/20/2023, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. There is a restroom directly accessible to the classroom. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly.

Food is provided from the Elementary School cafeteria. This facility provides breakfast and lunch.

At 9:25am, LPAs reviewed the outdoor play area. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is one outside play space that is separated from the rest of the elementary school play yard. There is a play structure, play house, benches, and age appropriate toys and equipment. Drinking water is readily available outdoors.

Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher during tour. The Licensee is within the conditions, limitations, and capacity specified on the license. All areas were identified on the Facility Sketch were inspected. A

At 9:45am, facility records were reviewed. Sign in and out is conducted on a tablet application called KinderSign which records the time of sign in and out for each child by the authorized adult. Disaster drills have been conducted at least every six months. Staff files were not reviewed during today's inspection due to staff files being kept at the Pasadena Unified School District office. They will be reviewed at a later date. A random sample of Children’s Records were reviewed to ensure that they are complete.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA was unable to see record of lead testing being conducted for the facility. Water fountains were observed to be operational in the classroom and the play yard. LPA is instructing the facility to conduct lead testing.

REPORT CONTINUES PAGE 2 of 3

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
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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: HAMILTON PRESCHOOL
FACILITY NUMBER: 191231022
VISIT DATE: 10/29/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Lead Teacher Antoineta Murrillo, at 10:30am. Plan of corrections were developed and Copy of Report provided.

END OF REPROT PAGE 3 of 3

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
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Document Has Been Signed on 10/29/2024 10:33 AM - It Cannot Be Edited


Created By: Nolan Tcheng On 10/29/2024 at 10:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HAMILTON PRESCHOOL

FACILITY NUMBER: 191231022

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 10/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in ensuring that Lead testing was conducted on the classroom and play yard drinking water fountains, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/12/2024
Plan of Correction
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Per Lead Teacher, the Pasadena Unified School District will register and have the water outlets tested. They will submit proof of registration to LPA by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ana Chico
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


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