<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014168
Report Date: 10/22/2021
Date Signed: 10/22/2021 11:12:21 AM

Document Has Been Signed on 10/22/2021 11:12 AM - 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 SAN GABRIEL / ROSEMEADFACILITY NUMBER:
198014168
ADMINISTRATOR:MARY PERALTAFACILITY TYPE:
850
ADDRESS:4930 EARLE AVENUETELEPHONE:
(626) 288-4400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 149TOTAL ENROLLED CHILDREN: 149CENSUS: 83DATE:
10/22/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director, Maria Rennard TIME COMPLETED:
11:15 AM
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
An unannounced Case Management visit was conducted on this date by Licensing Program Analyst (LPA) Bardo Baluyot following an outbreak reported to CCLD on 10/14/21. LPA conducted a COVID risk assessment prior to entry. Upon arrival, LPA was greeted by Director, Maria Rennard. All visitors including the LPA are requested to wash their hands prior to entering further into the facility. There is a hand washing station directly adjacent to the front entrance.

Census: There were 83 preschoolers present throughout the six pre school classrooms. Staff-child ratio was met.

During today's inspection, Director guided the LPA on a tour of the entire facility including all classrooms, restrooms, kitchen and outdoor areas. LPA observed all staff and children over two years of age wearing masks. LPA also observed all staff and parents to be following DPH guidelines regarding cleaning and daily operational guidelines. An interview was conducted with the Director (Staff #1) and current roster and DPH line list was obtained by the LPA. Per Director, two additional preschool children experienced similar symptoms since last contact and were added to the line list. Director added that these most recent cases were also single occurrences and the children were able to return to school within 48 hours. Director also confirmed that the second child who opted to test for COVID as a precaution received a negative result.

No deficiencies cited today and the facility is in compliance with Title 22. Upon receipt, Director Maria Rennard posted the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Director, Maria Rennard. Appeal Rights have been provided and explained to Director .
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Bardo Baluyot
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
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 1