198019097-5-9-2023-33-CC-CGRN-CRNSCV-20230509134611

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019097
Report Date: 05/09/2023
Date Signed: 05/09/2023 01:46:26 PM

Document Has Been Signed on 05/09/2023 01:46 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:	ST. ANDREW CATHOLIC PRESCHOOL		FACILITY NUMBER:	198019097
ADMINISTRATOR:	SERENA LEE		FACILITY TYPE:	850
ADDRESS:	42 CHESTNUT ST		TELEPHONE:	(626) 796-7697
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 12	CENSUS: 9	DATE:	05/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Serena Lee		TIME COMPLETED:	02:00 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) Crystal Green conducted an unannounced required 1- year inspection. LPA met with Director, Serena Lee. This facility is located in the same cite as St. Andrews Catholic School. Facility hours of operation are Monday through Friday from 7:30 a.m. to 6:00 p.m. The following was observed during this visit. At 12: 30 pm, LPA was provided a tour of the facility. This preschool program consists of 2 classrooms (Room 112 and Room 116). LPA observed there to be 9 children with 2 staff members in the Room 112. LPA observed did not observed children in Room 116. Per Director, the classroom is currently not in use. Teacher- child ratios were observed, and staff names were recorded. All children were observed by licensing staff to be under visual supervision of a teacher at all times. Licensing staff observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. LPA observed cots available within the classroom. Napping equipment was inspected for good condition, appropriate storage, and cleanliness. Bedding is stored separately in each child storage cubbies. LPA observed the children to have access to a restroom located within the classroom. All toilets and hand washing facilities are in safe and sanitary operating conditions. There is water available both indoors and outdoors via water fountains or the children uses their own sippy cups. The isolation area will continue to be in the Health Clerk's Office which is equipped with two beds and a restroom for ill children. Parents are contacted immediately when children are determined to be ill, and staff are ensuring that children with obvious symptoms of illness are not being accepted. Page 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 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: ST. ANDREW CATHOLIC PRESCHOOL	FACILITY NUMBER: 198019097
	VISIT DATE: 05/09/2023

NARRATIVE

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The children bring their own lunch and snacks or have an option for hot lunch. The facility does have snacks available, in the event that a child forgets their lunch or snack. Food preparation and storage areas are clean and free of litter. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children shall be made inaccessible.

Outdoor play equipment was observed to be in good condition. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Climbing equipment observed is surrounded by rubber surfaces. The facility has adequate shade available outside. LPA observed the drinking water fountains located in the outdoor play area
LPA reviewed the sign in and out sheets to ensure that parents are providing their signatures. Staff Records were reviewed to ensure that a health screening report is on file. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.

This facility provides Incidental Medical Services – IMS. Per Director, there are no children enrolled that require IMS. 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

There are no citations being issued today.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director, Serena Lee.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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