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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200048
Report Date: 09/26/2019
Date Signed: 09/26/2019 04:56:08 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:HOGG'S HOLLOWFACILITY NUMBER:
191200048
ADMINISTRATOR:ROSE HOGGFACILITY TYPE:
850
ADDRESS:4490 CORNISHON AVENUETELEPHONE:
(818) 790-1700
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY:26CENSUS: 15DATE:
09/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Rose HoggTIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Justin Dorsey conducted an unannounced Annual Random Inspection. LPA met with Rose Hogg, Director, who guided LPA on a tour of the facility. This is a preschool program which consists of 1 large classroom. This facility is located on La Canada Unified School District property.

LPA inspected all areas identified on the Facility Sketch. The facility consists of one classroom, during the visit LPA observed Staff #1, Staff #2 and Staff #3 in care of 15 children.

On 09/26/19, before entering the facility LPA observed Child #7 on the playground unsupervised. LPA observed child unsupervised for around 2 minutes before he was noticed by staff who came to open the front gate to let LPA into the facility. Per Director and Staff #2, Staff #2 was on the porch located on the outdoor play area. LPA did not observe any staff until he called the facility to gain entrance. Per Director Staff #2 was able to see 3/4 of the playground from where she was standing. LPA observed the child to be by the wagon garden in the playground.

Students have access to the classroom, restroom (located in the classroom) and outdoor play area. Students of the program are signed in at the main entrance by parents. This facility does not provide transportation children are dropped off and picked up by their parents. Furniture and equipment are safe and in good repair. There is telephone service, heating, lighting and ventilation available at the facility. The facility uses one of the teachers offices as an isolation area, per Director if needed ill children use the children's restroom in the classroom. LPA observed each child had two water bottles on the playground.

On 09/26/19 LPA observed that there was no water in the classroom. Per Director each parent brings their children two water bottles which are kept in individual coolers on the playground. LPA advised that each child take one of their water bottles inside so that children don't have to go to the playground to access water. During the visit a pitcher of water and cups were placed in the classroom.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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 5
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: HOGG'S HOLLOW
FACILITY NUMBER: 191200048
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2019
Section Cited

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101229 Responsibility for Providing Care and Supervision (a)(1)The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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Based on observation there was a child in the outdoor play area without direct supervision. Per Director and Staff #2, Staff #2 was on the porch near the out door play area. which poses an immediate Health, Safety or Personal Rights risk to children in care.
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: HOGG'S HOLLOW
FACILITY NUMBER: 191200048
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2019
Section Cited

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1596.841Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request. This requirement is not met as evidenced by:


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Based on observation the faciliy did not have a roster for children who are provided care in the facility, which poses an potential Health, Safety or Personal Rights risk to children in care.
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: HOGG'S HOLLOW
FACILITY NUMBER: 191200048
VISIT DATE: 09/26/2019
NARRATIVE
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On 09/26/19 LPA Dorsey found the facility did not have a roster for children in care.

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 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
REMINDER: Failure to obtain a criminal record background check clearance prior to initial presence will result in an immediate $100.00 dollar or more.

LPA advised how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. Also, discussed new requirements for providers, including mandate reporting training for staff which can be found at: http:/www.mandatedreporterca.com/training /training.htm. This is a new regulatory requirement beginning January 2018. According to staff, training has been completed through Community Care Licensing. Please review all elements outlined in AB 1207- Mandated Reporting Training.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care and new parents for up to one year. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided to the Licensee.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director Rose Hogg, The Notice of Site Visit and Appeal Rights were given.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: HOGG'S HOLLOW
FACILITY NUMBER: 191200048
VISIT DATE: 09/26/2019
NARRATIVE
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Restrooms used were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation.

The kitchen, which the students don't have access to is near the classrooms entrance. Per Director parents provide their children with lunch. If needed the facility has AM and PM snacks. According to the Director most parents bring snacks for their children. Containers used to discard food have tight fitting lid at this time. Snack menus were posted in the kitchen and class room. Snacks were reviewed for availability, quantity and appropriateness to children in care. Poisons, Cleaning compounds and sharp items are inaccessible.

The outdoor area includes climbing equipment for the children with cushioning for children if they fall. On the playground the children also have access to a fountain that is controlled by staff for water activities and a garden. The play area is fully fenced.



A review of records was conducted for staff and participants. LPA observed that staff have current First Aid and CPR (Expires 01/2020). Ratios were observed to be in compliance. Disaster drills are documented and all posting requirements have been met.

On 09/26/19 while reviewing staff files it was found that Staff #3 did not have proof of the MMR vaccination.

On 09/26/19 while observing the first aid kit, LPA Dorsey found that there were 3 different types of expired over the counter medications. During the visit the Director removed the medications from the first aid kit and threw them away off of the schools property.

Per Director there are no children in the program that take medications at this time.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5