191200190-1-2-2025-33-CC-POCA-DCJQCP-20250102110328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191200190
Report Date: 01/02/2025
Date Signed: 01/02/2025 11:03:41 AM

Document Has Been Signed on 01/02/2025 11:03 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	CHILDREN'S COUNTRY HOUSE		FACILITY NUMBER:	191200190
ADMINISTRATOR/ DIRECTOR:	NIELSON, DEBERA		FACILITY TYPE:	850
ADDRESS:	2821 SANTA ROSA		TELEPHONE:	(626) 798-8083
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY: 34	TOTAL ENROLLED CHILDREN: 15	CENSUS: 2	DATE:	01/02/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Director, Rebecca Robledo		TIME VISIT/ INSPECTION COMPLETED:	11:15 AM

NARRATIVE

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On January 2, 2025 at 9:00 am Licensing Program Analysts (LPAs) Priscilla Ochoa and Kamile Martin conducted an unannounced random annual inspection. LPA was greeted by Director Rebecca Robledo, who led LPAs on a tour of the facility. This is a Preschool program that operates Monday – Friday from 7:30 am – 6:30 pm. Per Director there are currently 15 children enrolled in the program. LPAs observed 2 children in care with 2 staff.

Upon entrance LPA observed all required forms/publications to be posted by front door into the hallway. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative.

At 9:10 am, LPAs toured and inspected the facility, which consist of 3 classrooms: Rm 1, Rm 2 and Rm 3. Room 1 no children were observed, Room 2: 2 children with 1 teacher, Room 3 is currently not in use.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children in care. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. LPAs observed both cots and mats stored in laundry room which is located through the bathroom in room 2. Bedding was also inspected for good condition, appropriate storage, and cleanliness. Per Director, children take their sheets and blankets home every Friday to be washed or they can be washed at the facility. 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. The facility was observed to be free of flies, other insects, and rodents. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water is readily available outdoors via personal water bottles and refills provided the facilities.

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Ana Chico	TELEPHONE: (323) 981-3379
Priscilla Ochoa	TELEPHONE: 323-981-3350
	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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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Document Has Been Signed on 01/02/2025 11:03 AM - It Cannot Be Edited

Created By: Priscilla Ochoa On 01/02/2025 at 10:45 AM

Link to Parent Document Below:

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: CHILDREN'S COUNTRY HOUSE	FACILITY NUMBER: 191200190
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/02/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 out of 2 staff have expired mandated reporter certificates, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/10/2025
	Plan of Correction
1 2 3 4	Director will provide LPA P. Ochoa proof of completed Mandated Reporter certificates by POC date of 1/10/2025

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ana Chico

TELEPHONE: (323) 981-3379

LICENSING EVALUATOR NAME:

Priscilla Ochoa

TELEPHONE: 323-981-3350

LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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: CHILDREN'S COUNTRY HOUSE	FACILITY NUMBER: 191200190
	VISIT DATE: 01/02/2025

NARRATIVE

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At this time, the Director’s office is being used as an isolation area. A mat or cot is available for an ill child to rest on. First Aid supplies are available and complete.

Facility has a functioning carbon monoxide and smoke detector that meets statutory requirements. Director states there are no weapons, firearms, or bodies of water on the premises.

A fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 8/16/2024, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly. All food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Snacks were reviewed for availability, quantity, and appropriateness to children in care. This facility provides all meals for children in care.

At 9:30 am, LPAs reviewed the bike outdoor play area and the big outdoor play area. 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. In the big outdoor play area in the far back, LPAs observed a pony, 3 goats and 2 chickens. Animals were away from children play in an enclose area. Per director, when children are near the animal area there is adult supervision at all times. Drinking water is readily available outdoors via personal water bottles and refills provided the facilities.

Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher during tour. The Licensee is within the conditions, limitations, and capacity specified on the license. All areas were identified on the Facility Sketch were inspected.

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. Disaster drills have been conducted at least every six months. Last emergency drill was conducted 11/25/2024.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file and deemed complete.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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: CHILDREN'S COUNTRY HOUSE	FACILITY NUMBER: 191200190
	VISIT DATE: 01/02/2025

NARRATIVE

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Staff files were reviewed for a health screening report and immunizations that meet regulatory requirements. Criminal Record Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. Facility will receive a technical violation for not maintain teacher transcripts available for LPAs to review during inspection.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

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

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: 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 child care 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 to the Written Directives outlined in PIN 21-21.1-CCP

LPA advised the Director to access forms, regulations and quarterly updates on the Childcare Licensing website at: www.ccld.ca.gov.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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: CHILDREN'S COUNTRY HOUSE	FACILITY NUMBER: 191200190
	VISIT DATE: 01/02/2025

NARRATIVE

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

Based on the LPA’s observations and record review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of the report was provided to Director, Rebecca Robledo.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3379
LICENSING EVALUATOR NAME: Priscilla Ochoa	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

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