Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000699
Report Date: 09/12/2017
Date Signed 09/12/2017 02:17:32 PM

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:HACIENDA LA PUENTE USD-TEMPLE SCHOOL P-4FACILITY NUMBER:
198000699
ADMINISTRATOR:Y. GUEVARA, R. MUNOZFACILITY TYPE:
850
ADDRESS:635 CALIFORNIA AVETELEPHONE:
(626) 933-1560
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:29CENSUS: 15DATE:
09/12/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lead Teacher Mahvel ZuvalaTIME COMPLETED:
01:15 PM
NARRATIVE
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An unannounced Required-3 year inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell. Upon arrival, LPA went into the Office and signed in and was guided (by pointing) to the pre-school classrooms by Darlene Quintana, an office staff from the Elementary School. P-4 is the only room licensed through CCL; it is located in a portable on the southwest side of the Temple Elementary School campus. The children share the playground with the T-K and Kindergarteners from the Elementary School. As there are no names associated to the license, all staff names are noted on the LIC 811 Confidential Names list. Child Development Director Teresa Figueras was present for approximately ten (10) minutes during today's inspection.

Upon arrival at P-4, there was a Lead teacher, Mahvel Gala-Zuvala, and a substitute Child Development technician with 15 children. At 12:00, Lead Teacher Maria Villa gomez and a CDT were with 16 six children. As P-4 is a Head Start, Title 22 regulations are applied.

There are two sessions, the AM, which runs 8:00-11:30, and the PM, which runs 12:00-3:30, Monday-Friday. There are 16 children currently enrolled in both the AM and the PM session (32 total). Both sessions are Head Start programs. All areas identified on the Facility Sketch were inspected, including the rest rooms, equipment, outside play area and overall conditions of facility. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink and toilet was inspected. Availability of drinking water was reviewed. Age-appropriate sinks and toilets were inspected for availability, good repair, water temperatures, soap, toilet paper, towels, area safety and sanitation. There are two First aid Kits, one for the A.M. session and one for the P.M. session; they are kept on the top shelf in one of the cabinets. Medication is kept locked (with a padlock and key) in the Lead Teacher's office, though there are no children in either session currently on medication. All required postings were observed on the Parent Board which is located adjacent to the door through which parents enter and exit the classroom (the
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2017
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: HACIENDA LA PUENTE USD-TEMPLE SCHOOL P-4
FACILITY NUMBER: 198000699
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2017
Section Cited
CCR
101216(f)
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PERSONNEL REQUIREMENTS
At least one person trained in CPR and Pediatric first aid shall be present when children are at the facility or offsite activities.


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The Lead Teachers have until 12/12/17 to renew their First Aid/CPR certificates. Child Development Director Teresa Figueras was informed that their cards/certificates need to say "Pediatric" on them.
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-Though Staff #4-6 have First Aid/CPR training, the First Aid is not Pediatric, but "Standard."
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2017
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: HACIENDA LA PUENTE USD-TEMPLE SCHOOL P-4
FACILITY NUMBER: 198000699
VISIT DATE: 09/12/2017
NARRATIVE
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rear of the portable.) The license and Emergency Disaster Plan are hung on the wall adjacent to the door which leads to the Elementary School playground. Breakfast, lunch, and snack menus are posted on the Parent Board and extras are kept on the top of the cubbies. It was stated that the school district provides all of the food. A review of cleaning supply storage area was made. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met appropriately. Sign in and out sheets were reviewed. Personal Rights of children were discussed and observed by LPA. The files of the four staff present (both the AM and the PM session) and three children's files from the AM session and two children's files from the PM session were reviewed for completeness including, but not limited to, required paperwork and verification of CPR/First Aid and health preventive practices documentation. There is a carbon monoxide detector located on the wall outside of the girls bathroom; it was tested and is operable.

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 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.

The following is being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for documentation of deficiencies.

Upon receipt, the Licensee shall post 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.

Exit interview was conducted with, and a copy of this report has been signed by and provided to Lead Teacher Hilda Mahvel Gala-Zuvala. Appeal Rights procedures provided and explained to Lead Teacher Hilda Mahvel Gala-Zuvala,
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2017
LIC809 (FAS) - (06/04)
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