Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290371
Report Date: 01/24/2020
Date Signed: 01/24/2020 12:39:27 PM

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:JEFFERSON CHILDRENS CENTERFACILITY NUMBER:
191290371
ADMINISTRATOR:REE HUDSONFACILITY TYPE:
850
ADDRESS:391 NORTH SIERRA BONITATELEPHONE:
(626) 796-8845
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:70CENSUS: 45DATE:
01/24/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Carolina ArizagaTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ariel Cazares and Nolan Tcheng conducted an unannounced annual/random inspection on this date. LPAs met with Site Supervisor Carolina Arizaga, whom led LPAs on a tour of the facility. The facility consists of 4 classrooms, 3 only currently being used. There were 45 children and 6 staff present. The facility is located on the campus of Jefferson Elementary School. Access to the facility can be gained through the side on Sierra Bonita Ave. It is physically separate from the elementary school via gates. Facility center hours are Monday through Friday, 7am-6pm.

LPAs toured all areas used by the children. Per Director, no alterations have been made and LPA observed none. The facility consists of 4 classrooms. Each classroom was inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Napping equipment is available in form of cots. There is available drinking water in form of water dispenser with disposable cups or water fountains. There are first aid and emergency supplies located in the cabinets of each classroom. LPAs tested the carbon monoxide detector located in Classroom 6 and found it to be operational. The children’s restroom is located in the classrooms were observed to be clean and in good condition, with sufficient supplies for children to use. Sinks and toilets are in functioning order.

LPAs inspected the children’s outdoor space. The playground was inspected for safety, cushioning material, good repair and age appropriateness. LPAs observed there to be shade and adequate fencing. Drinking water is available in form of a water fountain. LPAs found that fountains are functional.

The facility provides breakfast, lunch, snack catered from the Elementary School cafeteria. The menus were observed posted throughout the facility and classrooms. Any children with allergies are given alternative meals provided by the cafeteria.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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 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: JEFFERSON CHILDRENS CENTER
FACILITY NUMBER: 191290371
VISIT DATE: 01/24/2020
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Per director, the isolation area is located in the office. There is a small room and teacher's lounge available for ill children who need to rest. There is also a staff restroom made available for ill children to use. Medication is kept in each classroom for the child is corresponds to. LPA observed medication in classroom 4 for a child that no longer attends. LPA advised Supervisor to return medication to parent or remove from the classroom.

Teacher child ratios were observed to be in compliance. Care and supervision was evaluated to determine if the basic needs of children are met.

Children's records are kept on site and were reviewed. Staff files are kept at the main office located off-site. Sign in and out sheets were reviewed within each classroom. LPAs counted that 39 of 45 children were signed in. Six (6) children were not signed in on this date. LPA Cazares informed the Supervisor of those not signed in.

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 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

See attached deficiencies page for citations in accordance with Title 22 California Code of Regulations.



Exit interview conducted with Carolina Arizaga. A copy of this report and appeal rights were provided and explained. 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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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: JEFFERSON CHILDRENS CENTER
FACILITY NUMBER: 191290371
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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The person who brings the child to, and removes the child from, the center shall sign the child in/out.
This requirement has not been met as evidenced by LPAs review of sign in/out sheets revealing that 6 children present were not signed in. This poses a potential risk to the health and safety of children in care.

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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3