191501773-10-11-2024-33-CC-CTUA-D9XU25-20241011151121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191501773
Report Date: 10/11/2024
Date Signed: 10/11/2024 03:11:33 PM

Document Has Been Signed on 10/11/2024 03:11 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:	CLAREMONT UNITED METHODIST NURSERY SCHOOL		FACILITY NUMBER:	191501773
ADMINISTRATOR/ DIRECTOR:	JERI BOLLMAN		FACILITY TYPE:	850
ADDRESS:	211 W. FOOTHILL BLVD.		TELEPHONE:	(909) 624-8223
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY: 75	TOTAL ENROLLED CHILDREN: 61	CENSUS: 17	DATE:	10/11/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:50 PM
MET WITH:	Jeri Bollman		TIME VISIT/ INSPECTION COMPLETED:	03:45 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	On 10/11/2024 at 12:50 PM, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced annual inspection. LPA met with Director, Jeri Bollman who guided the LPA on a tour of the facility. This is a preschool age program licensed for 75 children which operates Monday through Friday from 7:30AM to 4:30PM. Per the Director there are 61 children currently enrolled. LPA observed a census of 17 children with 5 staff members and confirmed clearance. The following classrooms were inspected: yellow room (ages: 4yrs - 5yrs old): 10 children; purple room (ages:3 yrs - 4yrs old): 11 children; turquoise room (ages: 2yrs - 3yrs old): 10 children; green room (ages: 3yrs - 4yrs old): 13 children; blue room (ages: 2yrs old): 0 children. 1 bathroom is shared with the purple and yellow rooms with 3 toilets and 3 sinks. An additional bathroom is located near the blue classroom and has 2 toilets and 2 sinks. The blue classroom is not in use at this time and is an overflow but has a changing table with an arm’s reach sink for hand washing. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision, including visual supervision. Licensed facility is within the conditions, limitations, and capacity specified on the license. The classroom 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. All toilets and washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. The facility does not provide any food for the children in care but does provide water. Parents provide all meals for children in care. Food is stored in day care children’s backpacks/lunch boxes. Additional food is page 1 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

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: CLAREMONT UNITED METHODIST NURSERY SCHOOL	FACILITY NUMBER: 191501773
	VISIT DATE: 10/11/2024

NARRATIVE

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available just in case.

LPA observed a rabbit, finches (birds) and Bearded Dragon who are an enclosed cage or aquarium.

Napping cots are available for children to nap. Napping items are available to purchase from the facility and are sent home at the end of the week to be laundered.

LPA observed that there are functioning smoke and carbon detectors in the facility. LPA observed a fully charged and serviced fire extinguishers last checked on 7/18/2024. Emergency disaster drill was last conducted in July 2024. LPA encouraged earthquake drills to be conducted monthly.

Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Some of the areas have sand and Director stated that staff inspect prior to children playing and sand is also sifted for any dangerous objects. There are a total of 3 playgrounds available for children to play.

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 reviewed staff records, staff files were complete and all required licensing forms and training were complete including (Mandated reporter, First Aid and CPR, Immunization records, Influenza, LIC198, LIC503 and LIC508). Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

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.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: CLAREMONT UNITED METHODIST NURSERY SCHOOL	FACILITY NUMBER: 191501773
	VISIT DATE: 10/11/2024

NARRATIVE

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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.

Director 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 Childcare 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 Childcare 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 childcare 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). LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP. Director provided LPA with Lead documentation including results.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA observed a medication that expired June 2024 and reminded Director to return expired medication to parents and to keep track with a list of medications and dates or using a calendar reminder, 2 weeks prior to the expiration date. (Technical Violation was issued).

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/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: CLAREMONT UNITED METHODIST NURSERY SCHOOL	FACILITY NUMBER: 191501773
	VISIT DATE: 10/11/2024

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	At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Jeri Bollman. page 4 of 4

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024

LIC809 (FAS) - (06/04)

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