198019051-10-10-2022-33-CC-CRES-CK3LTP-20221010090237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019051
Report Date: 09/30/2022
Date Signed: 10/10/2022 09:04:46 AM

Document Has Been Signed on 10/10/2022 09:04 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MENDOZA C.D.C., RM. P9		FACILITY NUMBER:	198019051
ADMINISTRATOR:	KYM ALLEN		FACILITY TYPE:	850
ADDRESS:	851 S. HAMILTON BLVD.		TELEPHONE:	(909) 397-4438
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 32	CENSUS: 6	DATE:	09/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kym Allen		TIME COMPLETED:	12:25 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) Cynthia Reyes and Licensing Program manager (LPM) Christina Gabelman, conducted an unannounced annual inspection on this date. LPA met with Kym Allen, Facilities and Licensing Planner and a copy of the Entrance Checklist for Child Care Centers form (LIC 125) was provided. A risk assessment was conducted prior to entering the facility. Due to COVID- 19 precautionary measures were taken during the entire inspection and LPA wore appropriate personal protective equipment. This facility is located on the premises of Mendoza Elementary School which operates under Pomona Unified School District. The facility is licensed to care for 24 preschoolers in classroom P9. The new toddler option program capacity is 8 in room P10, no children are enrolled at this time. LPA observed the classrooms to each have their own entrance. This facility is currently active; however no children were present during this inspection. The Preschool program will operate Monday through Friday 7:30am to 11:00am (AM Session) and 11:45am - 3:15pm (PM Session). The program operates under the Pomona Unified School District calendar schedule 9AM Mr. Allen lead LPA & LPM on a tour of the facility beginning in the Toddler class room. No toddlers were in care on this date. Next tour was the preschool class room were the Sign-In and Sign-Out sheet was observed and signatures and dates and counts of children were observed. Physical check which include temperature being taken of children will be conducted by staff when the child enters the class room. Use of hand sanitizer will also be available. Facility was observed to be adhering to local public health guidelines. (According to CDC guidelines, children under the age of (2) are not required to wear masks.) Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were observed to be inaccessible to children. Mr. Allen states there are no poisons, weapons or firearms located at the facility. PAGE 1 OF 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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: MENDOZA C.D.C., RM. P9	FACILITY NUMBER: 198019051
	VISIT DATE: 09/30/2022

NARRATIVE

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Teacher-child ratios were discussed in accordance with Title 22 Regulations. Staff names were recorded. LPA discussed that children should be under supervision and observation, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license. The staff office will be used as an ill/isolation area for children. LPA observed an ill child cot/mat available. Ill children will use the staff restroom located outside the preschool play yard.

9:35 AM Furniture, equipment and toys were observed and inspected to be clean, safe and age appropriate and in good repair. Telephone service, heating, lighting and ventilation were evaluated. Preschool and toddler children have their own cubby to store their personal belongings. LPA observed napping equipment/bedding for children if needed as this is two half day programs, and was inspected to be in good condition, appropriate storage and cleanliness. Linens are washed weekly by an outdoor vender.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Menus for the past 30 days are available upon request. The facility offers breakfast and snack for the AM session and lunch and snack for the PM session. Food will be delivered daily from the central kitchen located at Garey High School. Snacks were reviewed for availability, quantity and appropriateness to children in care. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. The licensee takes measures to keep the facility free of flies, other insects and rodents. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair.

The outdoor playground was inspected and the play 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 adequate shade in the toddler yard, LPA advised Mr. Allen of shade needed in the preschool yard. LPA did not observe any bodies of water on the premises. The Preschool will request a waiver for shared space in the toddler yard.

There is drinking water available indoors and outdoors by use of pitcher/jugs and disposable cups. Sippy cups & water bottles will be labeled if brought by the child. Page 2 of 4

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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: MENDOZA C.D.C., RM. P9	FACILITY NUMBER: 198019051
	VISIT DATE: 09/30/2022

NARRATIVE

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Mr. Allen was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Children’s Records were reviewed for completeness; Inspection of required forms were made and documented on the LIC 857. LPA reviewed Staff records, which are documented on the LIC 859. Staff present have proof against TB, measles, pertussis, and influenza, as well as current Mandated reporter.

10:30 AM There is at least one person trained in CPR and Pediatric First Aid present during this inspection. Pediatric CPR & First Aid is current for the staff.

Medication: This facility provides Incidental Medical Services – IMS. No children at this time to review storage of medication and equipment/supplies, and no review of 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

Children's roster was reviewed. Disaster drill log was available and last drill was document 09/22/2022 and is posted visibly for all to see.

First Aid supplies were observed in each classroom and were observed to contain the required first-aid supplies. According to Mr. Allen medication is only administered to a child when accompanied with a doctor's note and is stored in the office. No transportation is being conducted by the facility.

Update: Effects of Lead Exposure and the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD. were discussed.
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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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: MENDOZA C.D.C., RM. P9	FACILITY NUMBER: 198019051
	VISIT DATE: 09/30/2022

NARRATIVE

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Carbon monoxide detectors and smoke detectors are present and are in operable condition in the facility. Smoke and Carbon Monoxide detectors should be checked, and batteries replaced as needed. LPA observed they are both located in each classroom, as well as the fire extinguisher type 2A-10BC and the valve on each indicated that they are all fully charged and each has a tag with a service date of 09/23/2021. Fire extinguishers need to be serviced annually or as often as necessary

Access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov. Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

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/process. ***(No care tool was used on this date, however documents were provided)***

There were no deficiencies cited during today’s inspection.

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

12:40PM Exit interview conducted and report was reviewed with the facility representative, Kym Allen, Facilities and Licensing Planner.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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