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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001061
Report Date: 06/20/2022
Date Signed: 06/20/2022 03:08:20 PM

Document Has Been Signed on 06/20/2022 03:08 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:KIDS KLUB PASADENAFACILITY NUMBER:
198001061
ADMINISTRATOR:VIVIAN CHANGFACILITY TYPE:
830
ADDRESS:380 SO. RAYMOND STREETTELEPHONE:
(626) 795-2501
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 31DATE:
06/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gloria Talavera, Assistant DirectorTIME COMPLETED:
03:15 PM
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On 6/20/22 at 8:30AM Licensing Staff Fabiola Vasquez and Claudia Guangorena conducted an unannounced one year required inspection. Upon arrival licensing staff began the tour of the infant program. Gloria Talavera, Associate Director (AD) arrived at 8:46 AM who continued and guided licensing staff on a tour of the facility. This is an infant program licensed for (55) infants ages 0 – 2 years. This facility operates Monday: 7:00 AM to 6:00 PM, Tuesday 7:00 AM-10:00 PM, Wednesday 7:00 AM-10:00 PM, Thursday 7:00 AM-10:00 PM, Friday 7:00 AM- 12:00 AM, Saturday 3:00 PM -12:00 AM. Per AD there are 74 infants enrolled. At 10:25 AM Vivian Chang, Regional Director (RD) arrived.

Licensee also has a preschool program (198001060) and a school-age program (198001062) located on the premises that is physically separate from the infant center both indoors and outdoors. Per AD the infant program does not share common areas with school age or preschoolers. All areas identified on this report were inspected. Per AD there are five classrooms. The following was observed during this visit.

In the Piglets (Infants 6 weeks to 10 months), room, Licensing staff observed (6) children with (3) staff, in the Pooh-Bears room, Licensing staff observed (6) infants with (3) staff members. In the Bumble Bees rooms: Licensing staff observed (5) infants with (2) staff members. In the Kangaroos A room, Licensing staff observed (9) infants with (3) staff members. In the Kangaroos B room, Licensing staff observed (5) infants with (3) staff members. There were a total of 31 infants and 14 staff present upon arrival. Teacher-Child ratios were observed to be in accordance with Title 22 Regulations.

All children were observed to be under visual supervision of a teacher. The Licensee is within the conditions, limitations, and capacity specified on the license.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
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 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: KIDS KLUB PASADENA
FACILITY NUMBER: 198001061
VISIT DATE: 06/20/2022
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The following was observed during the tour of the facility: The parents sign in and sign out through the iPad. AD provided a print out copy of the sign in and sign out sheets. At this time, an office located in the entrance hallway of the facility is used as the isolation area. Per AD the restroom across from the office will be used for the isolated children due to the restroom having a diaper changing station. Parents are contacted immediately when children are determined to be ill.

Disaster drill log was available, last drill was conducted on 5/10/22. LPA observed required licensing documents posted in the entrance to the facility. Daily activity schedule which provides time for active play, quiet play, rest, eating and toileting was observed. Facility disaster plan was observed and is complete.

Furniture and equipment were inspected for age appropriateness and good repair. Licensing staff observed in the Kangaroo B room the edges of a ramp, next to the magnetic board for children to play with, to be a tripping hazard. Telephone service, heating, lighting and ventilation were evaluated and are operable. There is at least one operable carbon monoxide detector.



Disinfectants, cleaning solutions and other items that are dangerous to children, were observed to be inaccessible in a locked room in the drop off entrance area on the back side of the facility. Per AD that there are no poisons stored at the facility and understands that storage areas for poisons must be locked.

Monthly menus were reviewed to ensure that they are being posted at least one week in advance and are visible to an authorized representative. There is also a monthly available for parent's to review. The facility provides AM snack, lunch and PM snack.

Facility stores AM and PM snack in the classroom. Lunch is prepared and provided from the kitchen area. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment have cushioning material to absorb a fall. AD states that there are no bodies of water on the premises and licensing staff did not observe any bodies of water during this visit. AD states there are no weapons or firearms on the premises.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
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: KIDS KLUB PASADENA
FACILITY NUMBER: 198001061
VISIT DATE: 06/20/2022
NARRATIVE
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All individuals present have obtained a criminal record clearance or criminal record exemption. All staff present are trained in CPR and Pediatric First Aid, certificates are current. Staff’s Records were reviewed and are complete. Children's records were reviewed and are complete.

Licensing staff observed that facility has implemented COVID-19 precautions and procedures that they are following and parent's are following as well.

Infant Care: Licensing staff observed 10 infants in the napping room. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. Licensing staff did not observe loose objects, bumpers, objects hanging, or objects attached to the cribs. Per AD wet or soiled sheets are cleaned daily. Each infant has their own crib and bedding. Licensing staff discussed with AD and RD the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Licensing observed that the napping room is also used as an activity room. Per RD the napping room will be reconfigured back to a napping room only since the napping are and the activity area are to be kept separate. A Technical Violation was provided.

Incidental Medical Services – IMS. LPA Vasquez 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

There were no deficiencies cited during today’s visit.


Licensing staff discussed the safe sleep regulations with Associate Director, Gloria Talavera and Regional Director Vivian Chang. Discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Associate Director, Gloria Talavera and Regional Director Vivian Chang 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.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
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: KIDS KLUB PASADENA
FACILITY NUMBER: 198001061
VISIT DATE: 06/20/2022
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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.

Facility Representative 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.

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 conducted and report was reviewed with the Associate Director, Gloria Talavera and Regional Director Vivian Chang.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022
LIC809 (FAS) - (06/04)
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