198010409-9-17-2024-33-CC-SSAN-D97SR6-20240917140547

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010409
Report Date: 09/17/2024
Date Signed: 09/17/2024 02:05:55 PM

Document Has Been Signed on 09/17/2024 02:05 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	SIERRA MADRE EARLY CHILDHOOD PROGRAM		FACILITY NUMBER:	198010409
ADMINISTRATOR/ DIRECTOR:	PATRICIA GUZMAN		FACILITY TYPE:	850
ADDRESS:	141 W. HIGHLAND AVE		TELEPHONE:	(626) 355-1428
CITY:	SIERRA MADRE	STATE: CA	ZIP CODE:	91024
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 25	CENSUS: 10	DATE:	09/17/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:59 AM
MET WITH:	Xotchil Bajo		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

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On 09/17/24, at 12:00 PM Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced annual random inspection. The preschool is located on the grounds of Sierra Madre Elementary School in classroom 127 located near the parking lot off of Auburn Ave. At 12:30 pm. LPA met with Facility Representative, Xochitl Bajo. LPA toured the facility. LPA observed 10 children present with 7 staff members .This is a preschool age program which operates Monday through Friday from 07:45 am to 10:45 am and 11:15 am to 2 :15 pm. Program consists of 1 classroom. Per Facility Representative there are 29 children enrolled for both programs .

LPA observed all required forms/publications posted in the classroom .
The classroom furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free. All toilets and washing facilities are in safe and sanitary operating conditions.
First Aid supplies are available and complete in classroom .Storage for children's belongings was inspected.

LPA observed that there are functioning smoke and carbon detectors in the facility. LPA observed a fully charged and serviced fire extinguisher with the service date 12/14/23. Emergency disaster drill conducted along with school every months . Facility representative states there are no weapons, firearms, or bodies of water on the premises.

Facility provides breakfast for the morning program and lunch for the afternoon program . Breakfast and lunch provided by school cafeteria . LPA observed snack menus posted in the classroom one week in advance where it is visible by the child's authorized representative.

All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors via water bottles , children bring their own water bottles too. The facility was observed to be free of flies, other insects, and rodents. Page 1 of 3

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SIERRA MADRE EARLY CHILDHOOD PROGRAM	FACILITY NUMBER: 198010409
	VISIT DATE: 09/17/2024

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The corner of the class used as isolation area . Cot is available upon request.

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, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

Facility uses Care Connect for sign in and out . Each family member has assigned pin number to sign in and out .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.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Inspection of required forms was made and documented on the LIC 857.

No staff files were reviewed during today's visit. Staff files are kept at PUSD's main office located at 351 S. Hudson Ave. Pasadena, CA. 91109 (626)396-3600.

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

LPA also informed facility representative 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: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SIERRA MADRE EARLY CHILDHOOD PROGRAM	FACILITY NUMBER: 198010409
	VISIT DATE: 09/17/2024

NARRATIVE

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Facility Representative 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 Child Care 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.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care 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 and no exceedance was reported .

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. 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.

Based on the LPA`s observations and record review the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview conducted and report was reviewed with facility representative Xotchil Bajo on 09/17/24.

A notice of site visit was given and must remain posted for 30 days.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

LIC809 (FAS) - (06/04)

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