191204862-5-23-2023-33-CC-CGRN-CS4QTH-20230523122707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191204862
Report Date: 05/23/2023
Date Signed: 05/23/2023 12:27:23 PM

Document Has Been Signed on 05/23/2023 12:27 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:	HARRIET TUBMAN PRESCHOOL		FACILITY NUMBER:	191204862
ADMINISTRATOR:	JOHNSON, WILLIE MAE		FACILITY TYPE:	850
ADDRESS:	36WEST MONTANA STREET		TELEPHONE:	(626) 794-5620
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY: 9	TOTAL ENROLLED CHILDREN: 9	CENSUS: 7	DATE:	05/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Willie Mae Johnson		TIME COMPLETED:	12:45 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. Licensing Staff met with Director, Willie Mae Johnson. Facility operation hours are from Monday to Friday from 8:00 AM to 5:00 PM. Entrance to the preschool program is via a wooden gate to the left of the facility in the rear building. There is also another program operating on this premises named Harriet Tubman Elementary, a private school age program which is overseen by CA Department of Education. LPA observed the preschool program operating separately from the private elementary school. The following was observed during this visit. At 10:20 AM, Licensing staff observed 7 children with 1 staff member in the preschool classroom. Teacher-child ratios were observed. 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 the preschooler’s restroom to be located in the front facility. Per the Director, the restroom is designed for preschoolers use only. All toilets and hand washing facilities are in safe and sanitary operating conditions. The ill isolation area is located in in an area in the classroom which can be barricaded via a gate. 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. Children are signed in by parents upon entry to their designated classroom.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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: HARRIET TUBMAN PRESCHOOL	FACILITY NUMBER: 191204862
	VISIT DATE: 05/23/2023

NARRATIVE

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Parents provide lunches and snack for their child. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. There is drinking water accessible to the children in care via water cooler dispenser and personal sippy cups. Per the Director, children do use the water faucets for drinking and the facility do not prepare food on the premises.

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. Areas around and/or under climbing equipment, swings and slides have cushioning material to absorb a fall. The outdoor play area was observed to be fenced and water is brought outside via water jug and cups. There are umbrellas available for shade.

Staff Records were reviewed to ensure that a health screening report is on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be 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

At this time, the licensee is in compliance with California Title 22 Regulations. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted with Director, Willie May Johnson. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Crystal Green
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC809 (FAS) - (06/04)

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