198020471-9-29-2021-33-CC-TRAO-C7BV8T-20210929161316

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020471
Report Date: 09/29/2021
Date Signed: 09/29/2021 04:14:20 PM

Document Has Been Signed on 09/29/2021 04:14 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:	ACACIA MONTESSORI SCHOOL COVINA INC.		FACILITY NUMBER:	198020471
ADMINISTRATOR:	MILDRED BAUTISTA		FACILITY TYPE:	850
ADDRESS:	450 W ROWLAND ST		TELEPHONE:	(626) 966-9356
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 0	CENSUS: 48	DATE:	09/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Mildred Bautista, Director		TIME COMPLETED:	04:00 PM

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On 9/29/2021 at 10:49AM, Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Required - 1 year inspection. LPA introduced self and met with Director Mildred Bautista and stated the purpose of the visit. LPA provided Director with a copy of the LIC 125 Entrance Checklist to facilitate the inspection. This is a preschool program which consists of 4 classrooms namely Dragonflies (previously known as Mustang), Busy Bees I (previously known as Eagle), Busy Bees II (previously known as Busy Bees), and Butterflies. Hours of operation is from Monday to Friday, 6:30 AM to 6:30 PM.

LPA was guided to a facility tour by Director at 11:18AM. All areas identified on the Facility Sketch were inspected. The following staff were present during this inspection: Dragonflies: Staff #1-3 with 22 children; Busy Bees I: Staff #4-5 with 18 children; Butterflies: Staff #6-7 with 8 children; and Busy Bees II has no children. The facility was observed to be within the license capacity and limitations.

The following were observed during the tour of the facility:

Furniture and equipment were inspected for age appropriateness and good repair, telephone service, heating, lighting and ventilation were evaluated. All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic free. Per Director, there were no firearms stored on the premises and no pools or bodies of water. Children have their own cubby to store their belongings. Children bring their own blankets and sheets and have them sent home on Fridays. Per Director, the isolation area is located in the office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in the classroom.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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: ACACIA MONTESSORI SCHOOL COVINA INC.	FACILITY NUMBER: 198020471
	VISIT DATE: 09/29/2021

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Disinfectants, cleaning solutions, and other items that are dangerous to children were inaccessible. Director states that there are no poisons stored at the facility. Carbon monoxide detectors were tested and were operable. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin.

All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. Children bring their own breakfast and lunch while facility provides morning and afternoon snacks. Snack menu was observed to be posted.

Outdoor playground equipment is in a 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. The outdoor surface is cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. LPA advised that no children shall be left without the supervision of a teacher at any time.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file. Staff present have proof against TB, measles, pertussis, and influenza. All staff have been given on the-job training on sanitation principles, housekeeping, including universal health precautions.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in.

First Aid supplies were observed in the classroom in a cabinet. According to the Director, there are currently no children on medication.

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

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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: ACACIA MONTESSORI SCHOOL COVINA INC.	FACILITY NUMBER: 198020471
	VISIT DATE: 09/29/2021

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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.

For additional information regarding Compliance and Regulatory Enforcement (CARE) tool used on today's inspection, please visit the program website at www.cdss.ca.gov/inforesources/community-care-licensing/tion-process. Please share your inspection experience by completing the survey to help improve the inspection process.

There were no deficiencies cited during today’s inspection.

A Notice of Site visit was posted and must remain for 30 days.

Exit interview conducted. Appeal Rights and report were reviewed with Director Mildred Bautista.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

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