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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002364
Report Date: 08/05/2022
Date Signed: 08/05/2022 01:52:34 PM

Document Has Been Signed on 08/05/2022 01:52 PM - It Cannot Be Edited

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:ROOSEVELT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198002364
ADMINISTRATOR:KYM ALLENFACILITY TYPE:
850
ADDRESS:701 N. HUNTINGTON BLVD.TELEPHONE:
(909) 397-4622
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 0DATE:
08/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kym Allen TIME COMPLETED:
02:00 PM
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An announced pre-licensing site inspection was conducted today by Licensing Program Analyst (LPAs) Cynthia Reyes and Crystal Green to inspect and measure facility for capacity determination. Licensee is requesting to decrease the preschool capacity and add a new toddler option program to the existing license. Licensing staff met with Kym Allen, Facilities and Licensing Planner, who guided analysts on a tour of the facility.

This facility is located on the premises of Roosevelt Elementary School which operates under Pomona Unified School District. The designated preschool classrooms will be classrooms B102 and B103 and the designated toddler option classroom will be in classroom B101. LPAs observed the classrooms to each have their own entrance. This facility is currently on inactive status and licensing staff did not observe any children present during this inspection. Per Mr. Allen, the previously licensed classrooms (HS 40 and HS41) no longer exists due to the facility underwent remodeling/ construction work.

The facility operating hours for the preschool classroom (B102) will offer a (2) part-time session, in the AM from 7:30am to 11am and the PM from 11:45am to 3:15pm. The preschool classroom (B103) will offer a full day session from 7:30am to 2:30pm. The Toddler Option Program (B101) will also offer a full- time session from 7:30am to 3:15pm.

Licensing staff was guided through a tour of the newly constructed classrooms (B101, B102, and B103). Licensing staff observed the toddler classroom to have a restroom located within the classroom. The children in the toddler room will have access to 2 toilets and 3 sinks. There is a changing table located within the restroom area. There is also a kitchen area located in the classroom which contains a refrigerator, microwave, and a sink. The designated preschool classrooms (B102 and B103) was observed to have a restroom within each classroom. The preschoolers will have access to 2 toilets, 3 sinks and a changing table. LPA observed the classroom to each have a kitchen area which contain a refrigerator, microwave, and a sink.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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: ROOSEVELT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198002364
VISIT DATE: 08/05/2022
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All toilets and sinks are in safe and sanitary operating conditions. Individual storage space will be available for each child inside the classroom. Furniture and equipment were inspected for age appropriateness and good repair. There are smoke detectors and fire extinguishers located throughout the premises. There is a fully equipped first aid kit available in the office. Locking medications cabinets are located in each classroom.

The designated isolation area for a toddler will be located within classroom B101 in the staff workroom which was observed to be physically separate within the classroom. Per Mr. Allen, the designated isolation area for an ill preschooler will be the staff workroom located between B102 and B103. Ill children will use the staff restroom located near classroom B103.

Licensing staff was guided through the proposed outdoor activity space. LPA observed the outdoor activity space to only have one outdoor space available for children in care. Per Mr. Allen, the toddlers currently do not have their own physically separate yard. The outdoor area was observed to have a secured fence surrounding the property. There is adequate shade in outdoor play area available via canopy sails. All areas around or under high climbing equipment, and slides were observed to have cushion material to absorb a fall. Both the preschool and toddlers will walk out the back classroom door and will lead them directly to their enclosed play yard.

Facility will provide snacks, breakfast, and lunch for the children in care. Children will bring their own sippy cup for water due to COVID-19 precautionary measure.

No transportation is being conducted by the facility.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
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: ROOSEVELT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198002364
VISIT DATE: 08/05/2022
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Licensing staff obtained measurements from both indoors and outdoors. The indoor capacity for the preschool classroom B102 measured for a capacity of 29, preschool classroom B103 measured for a capacity of 33, and the toddler option classroom B101 measured for a capacity of 29. Measurements obtained for the outdoor activity space allows for a capacity of 22. Licensing staff advised Mr. Allen that a waiver request will need to be submitted requesting shared usage of the outdoor space for the preschoolers due to the outdoor capacity being limited to 22 children at one time and a separate waiver request to allow toddlers to share usage of the outdoor space with preschooler on a separate staggered schedule. All waivers are subject to review and final approval by the Regional Office.

Exit interview conducted and report was reviewed with the Kym Allen, Facilities and Licensing Planner.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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