198020768-6-4-2021-33-CC-CGRN-C3NTUR-20210604150247

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020768
Report Date: 06/04/2021
Date Signed: 06/04/2021 03:03:00 PM

Document Has Been Signed on 06/04/2021 03:03 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:	MARYVALE		FACILITY NUMBER:	198020768
ADMINISTRATOR:	CRYSTAL REYNOLDS		FACILITY TYPE:	840
ADDRESS:	7600 GRAVES AVE		TELEPHONE:	(626) 537-3311
CITY:	ROSEMEAD	STATE: CA	ZIP CODE:	91770
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 0	DATE:	06/04/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Christian Moore		TIME COMPLETED:	03:15 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	An announced pre-licensing site inspection was conducted today by Licensing Program Analyst (LPA) Crystal Green to inspect and measure facility for capacity determination. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment. Applicant is seeking to provide care for 20 School- Age children. Licensing staff met with Vice President, Christina Moore, who guided analyst on a tour of the facility. Also, present during this inspection was the Assistant Director, Marcela Torres. The Center will serve as a full day school age program for children TK – 11 years old. Proposed operating hours of school-age program will be from Monday to Friday from 7:00 am - 6:00pm. There is also a licensed Infant program (1980096580) and Preschool program (191500469) located on this site. At 1:10 PM, Licensing staff was guided through a tour of the proposed school-age program. The proposed school-age classroom will be located in the Logsden building in room (14). LPA observed a drinking water available in the room via water jug and disposable cups. Furniture and equipment were inspected for age appropriateness and good repair. There is a fully equipped first aid kit available in the classroom. The school-age component will have separate restrooms to allow for privacy. LPA observed facility to have a designated boy’s restroom with 2 toilets, 1 urinal and 2 sinks and a designated girl’s restroom with 3 toilets and 2 sinks. All toilets and sinks are in safe and sanitary operating conditions. Page 1 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

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: MARYVALE	FACILITY NUMBER: 198020768
	VISIT DATE: 06/04/2021

NARRATIVE

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Due to COVID- 19 precautionary measures, staff states that check-in will take place at the entrance of the gym by use of hands-free check in. LPA observed a check-in table place at the entrance of the gym were staff conducted temperature check and COVID-19 symptoms screening. LPA observed postings relating to COVID-19 safety precautions available thorough out the facility. If child/ren become ill during the course of the day, they will be placed in the isolation area located in the director’s office. Ill children will use the staff bathroom. There are smoke detectors and a carbon monoxide detector on site that meets statutory requirements.

At 1:20 AM, LPA was guided through the outdoor activity space designated for preschool children. The applicant plans to request an outdoor waiver in order to share the preschool outdoor activity space on a staggered schedule with the school-age program. LPA observed the surface of the outdoor activity space is maintained in a safe condition and is free of hazards. There is adequate shade available for children along with tables and benches. No transportation is being conducted by the facility. This facility will provide Breakfast, Lunch, and PM snacks for children in care. Food will be provided by onsite central kitchen.

This facility plans to provide Incidental Medical Services- IMS. For IMS information, see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS was 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 Page 2 of 3

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MARYVALE	FACILITY NUMBER: 198020768
	VISIT DATE: 06/04/2021

NARRATIVE

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During an inspection conducted on 9/04/2019, measurements of the preschool outdoor activity space were obtained. The preschool outdoor yard measured for a capacity of 196 children. Based on the measurements obtained during this inspection for the proposed school-age classroom the capacity will be twenty (20) children. The applicant has submitted a waiver request to allow shared usage of the preschool yard on a staggered schedule. LPA obtained pictures of the preschool yard. All waivers are subject to review and final approval by the Regional Office.

Exit interview was conducted with Vice President and Assistant Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

Report Ends Page 3 of 3.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021

LIC809 (FAS) - (06/04)

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