191500336-9-8-2022-33-CC-FVAZ-CJ3STU-20220908141007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191500336
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:10:30 PM

Document Has Been Signed on 09/08/2022 02:10 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:	DE ANZA SCHOOL HEAD START/STATE PRESCHOOL		FACILITY NUMBER:	191500336
ADMINISTRATOR:	DAHLEN, MOLLY & TALAVERA		FACILITY TYPE:	850
ADDRESS:	12820 EAST BESS ST.		TELEPHONE:	(818) 962-3311
CITY:	BALDWIN PARK	STATE: CA	ZIP CODE:	91706
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 33	DATE:	09/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Nancy Sanchez, Program Manager		TIME COMPLETED:	01:05 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	On 09/08/22 at 10:50 AM Licensing Program Analysts (LPAs) Fabiola Vasquez and Enjoli Maeweather conducted an unannounced Required I year inspection. Facility is located on the campus of De Anza Elementary School. Upon arrival LPAs met with Nancy Sanchez, Program Manager who guided LPAs on a tour of the facility, upon arrival LPAs observed in Room One: 16 children with 3 staff, in Room Two: 17 children with 3 staff. The Head Start program reopened on 8/18/22, after summer break, currently it is operating Monday thru Friday as an extended full day program operating from 8:00 AM to 2:30 PM. Teacher-child ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. Per Program Manager all staff are Criminal Record Cleared prior to being hiring. During this inspection, all children were observed to be under visual supervision of a teacher at all times. LPAs observed required forms to be posted on the entrance of each classroom,, LPAs observed the following: Facility License, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Fire Drills conducted on 08/30/22. LPAs 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 surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, the quite area is used as the isolation away from the children. Ill children use the adult restroom. PAGE 1 OF 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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: DE ANZA SCHOOL HEAD START/STATE PRESCHOOL	FACILITY NUMBER: 191500336
	VISIT DATE: 09/08/2022

NARRATIVE

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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.

Snack menus were observed, breakfast, lunch are provided.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Fire extinguisher service-date: 7/14/22.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. LPA's observed age appropriate toys and equipment for children in care. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Program Manager states that there are no bodies of water on the premises and LPA's did not observe any bodies of water during this. Director states there are no weapons or firearms on the premises.

LPAs observed outdoor in the play yard a closed sliding gate with a metal chain attached to a lock wrapped around the poll of the sliding gate and the pole of the fence. LPAs observed a gap (Space) where the gate can slide open when pulled back while closed and locked with the chain. Program Manager wrapped the metal chain tighter to bring the sliding gate door closer to the fence pole eliminating the gap. Per Program manager she is putting a work order ticket and follow up on it.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA's observed all children present to be signed in.

Staff Records; Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, health preventive practices documented, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights. Staff files were not reviewed during today’s visit.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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: DE ANZA SCHOOL HEAD START/STATE PRESCHOOL	FACILITY NUMBER: 191500336
	VISIT DATE: 09/08/2022

NARRATIVE

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Per Program Manager, staff have the requirements and qualification prior to hiring. Files are located in the ECE Center on 13307 Francisquito Ave, Baldwin Park, CA 91706. LPA will review staff records on another day.

Children’s Records: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record. Children’s files were not reviewed during today’s visit.
Per Program Manager, Files are located in the ECE Center on 13307 Francisquito Ave, Baldwin Park, CA 91706. LPA will review staff records on another day.

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.html

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There were no deficiencies given during this inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed along with appeal rights with the Nancy Sanchez, Program Manager. PAGE 3 OF 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC809 (FAS) - (06/04)

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