340319282-9-11-2023-03-CC-KWIS-CVKQ9R-20230911115845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 340319282
Report Date: 09/11/2023
Date Signed: 09/11/2023 11:59:03 AM

Document Has Been Signed on 09/11/2023 11:59 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	PASADENA STATE PRESCHOOL		FACILITY NUMBER:	340319282
ADMINISTRATOR:	BAGELMANN, LINDA		FACILITY TYPE:	850
ADDRESS:	4330 PASADENA AVENUE		TELEPHONE:	(916) 575-2374
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 25	CENSUS: 16	DATE:	09/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Linda Bagelmann		TIME COMPLETED:	12:15 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	Licensing Program Analysts (LPAs) Kyrsten Williams and Amanda Sutter met with facility representative, Linda Bagelmann for an unannounced annual inspection of this preschool facility. Census included 16 children in care with 3 staff and a student volunteer. Facility is operating within the capacity and in compliance with staff child ratio on this day. Facility representative was reminded never to exceed the conditions, limitations and capacity specified on the license. Facility hours of operation are Monday through Friday 8:00 AM to 2:30 PM. With the facility representative, LPAs inspected the facility, including all activity and classroom spaces, restrooms, and outdoor play area. There are no pools, spas, or other bodies of water at the facility. The facility has at least one functioning smoke detector, carbon monoxide detector, fire extinguisher, and first aid equipment. There is a working telephone at the site. All the cleaning solutions, poisons and other chemicals that are dangerous to the children are stored inaccessible to the children. Classrooms all appeared clean, including the carpets and floor. The play yard is free of hazards. All playground equipment and surfaces were inspected and are in good condition, with enough resilient material under climbing structures to absorb a fall. There are shaded areas for the children. The facility has age-appropriate furniture. The furniture is steady and in good repair. The facility has enough sleeping matts. The facility floor is in good repair and free of any hazards. All toilets, hand washing facilities are in working condition with proper sanitation in place. The facility provides breakfast and lunches. LPAs did not observe a posted menu and observed food stored at safe temperatures with labels. Drinking water was readily available to children both indoors and outdoors. LPAs reviewed with Licensee the UC 311A, Records to Be Maintained at The Facility, for child's records, personnel records, administrative records, and documents to be posted. Children’s and staffs' files were reviewed. Each child's file had the required licensing documentation. *PAGE 1. REPORT CONTINUES ON LIC809-C*

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

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 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PASADENA STATE PRESCHOOL	FACILITY NUMBER: 340319282
	VISIT DATE: 09/11/2023

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
26
27
28
29
30
31
32

LPAs reviewed staff transcripts and observed all staff caring for children were qualified. At least one staff has a current Pediatric CPR and First Aid certification. Staff do not have current approved Mandated Reporter certificates. LPAs observed proof of immunization for each staff. LPAs observed a current children's roster and a fire drill log. LPAs observed all required licensing documentation was posted for parental review. LPAs observed that parents are signing their children in and out of the center.

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.

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). LPAs referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information.

The director 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.

LPAs discussed the safe sleep regulations with CDA and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed CDA of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
PAGE 2. REPORT CONTINUES ON LIC809-C

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PASADENA STATE PRESCHOOL	FACILITY NUMBER: 340319282
	VISIT DATE: 09/11/2023

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
26
27
28
29
30
31
32

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.

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.

Deficiencies are cited on the subsequent page of this report (LIC809-D) under the California Code of Regulations, Title 22. The licensee was provided a copy of their Appeal Rights (LIC9058) and the licensee's signature on this form acknowledges receipt of these rights.

Exit interview conducted and report was reviewed with the facility representative. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Kyrsten Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

Document Has Been Signed on 09/11/2023 11:59 AM - It Cannot Be Edited

Created By: Kyrsten Williams On 09/11/2023 at 11:18 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PASADENA STATE PRESCHOOL	FACILITY NUMBER: 340319282
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in the bathroom was not in clean and sanitary condition, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2023
	Plan of Correction
1 2 3 4	LPA will return to inspect the bathroom.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of 3 staff do not have an approved Mandated Reporter Training, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2023
	Plan of Correction
1 2 3 4	Staff will complete an approved Mandated Reporter Training and submit verification to LPA. Training can be found at www.mandatedreporterca.com

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:

Seychelle De Luca

LICENSING EVALUATOR NAME:

Kyrsten Williams

LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6