191202198-11-22-2019-12-CC-IORA-BJ7459-20191122174734

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202198
Report Date: 11/22/2019
Date Signed: 11/22/2019 05:47:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	WOODEN SHOE NURSERY SCHOOL, THE		FACILITY NUMBER:	191202198
ADMINISTRATOR:	MARTHA T VELOZ		FACILITY TYPE:	850
ADDRESS:	1525 GLENOAKS		TELEPHONE:	(818) 365-1513
CITY:	SAN FERNANDO	STATE: CA	ZIP CODE:	91340
CAPACITY:	74	CENSUS: 14	DATE:	11/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Martha T Veloz		TIME COMPLETED:	05:48 PM

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	On 11/22/19, Licensing Program Analyst(LPA) Isabel Ortega met with Director, Martha T Veloz to conducted an unannounced Annual Random inspection. LPA announced the purpose of the inspection and was granted entry to the facility. LPA toured and inspected the facility. Upon arrival LPA observed 14 children in care. Facility’s operational hours are Monday – Friday from 7:00 AM to 6:00 PM. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed individual storage with children’s name labeled for children's belongings. Each classroom has filter water with pitchers and cups available for children. An isolation area was inspected, which is located inside the main office. Children are provided with a cot for nap time. Age appropriate sinks and toilets were inspected for availability and in good repair. Toilets flush properly; toilet and sinks are reachable by the children. Each rest-room has adequate toilet paper, paper towels and soap available. Each classroom has a child restroom available and found to be clean and sanitary. First Aid supplies, smoke detectors, carbon monoxide and fire extinguishers(last serviced on 11/6/2019)were observed and in operable condition. Trash cans with tight lids were observed. The center provides food for the children enrolled. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. There is hot and cold running water in the kitchen/food preparation area. Food preparation area is adequately equipped, clean, and free from hazards. Cleaning supplies are out of reach of children and stored separately and away from food. Menu is posted for parents review.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: WOODEN SHOE NURSERY SCHOOL, THE	FACILITY NUMBER: 191202198
	VISIT DATE: 11/22/2019

NARRATIVE

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The outdoor play areas were inspected and observed to be free of hazards, loose, or sharp objects. Emergency drills are conducted monthly last drill was conducted on 10/17/19 at 10:17 AM. Equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures other large play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. The outdoors has water fountains readily available for children. Children are also provided their own individual labeled water bottle. There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area.

During the inspection LPA observed adequate teacher child ratio in each classroom. Care and supervision were evaluated and determine basic needs of children are appropriate and are being met. A review of the sign in/out sheet was conducted to verify the current census of children. The parent board was reviewed and has all the required forms posted accessible to parents.

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records and Blue cards are all in the children's files. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number. Director and teachers are currently certified in Pediatric CPR/First Aid which expires on 08/28/2020.

The following Incidental Medical Services (IMS) were discussed.
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

A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: WOODEN SHOE NURSERY SCHOOL, THE	FACILITY NUMBER: 191202198
	VISIT DATE: 11/22/2019

NARRATIVE

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Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Director is aware self and all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hot-line at (800) 540-4000. Director and staff demonstrated Mandated Reporter Training certificate dated 3/08/18.

Facility was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department

For additional information and forms visit our website at: www.cdss.ca.gov

Safe Sleep regulations were discussed with Licensee and referred to the CCL web site for additional information and PINS.

Went over new immunization new regulations and requirements which were effective 7/01/2019. New Regulation regarding varicella(chickenpox) vaccination now due at 15 months month instead 18 months.
For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

The facility was in compliance per Title 22 regulations, no deficiencies will be cited today 11/22/19. An exit Interview was conducted with Director Martha T Veloz, a copy of this Report, appeal rights and Notice of Site visit was provided.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

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