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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191204631
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:37:00 PM


Document Has Been Signed on 09/12/2022 02:37 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:SUSANNA WESLEY CHILDREN'S CENTERFACILITY NUMBER:
191204631
ADMINISTRATOR:MORENA DURANFACILITY TYPE:
850
ADDRESS:134 N. KENWOOD ST.TELEPHONE:
(818) 548-6229
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:36CENSUS: 20DATE:
09/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Morena Duran, DirectorTIME COMPLETED:
12:20 PM
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Licensing Program Analysts (LPA) Anomeh Eivazian and Enjoli Maeweather conducted an unannounced annual inspection on 09/12/2022 at 8:40 AM. LPAs met with Brenda Gonzalez-Cortez, Teacher who guided LPAs on a tour of the facility . LPA Eivazian provided teacher, Brenda Gonzalez-Cortez with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). This is a preschool program located at the First United Methodist Church of Glendale property. Director, Morena Duran arrived at the facility at 9:40 a.m.. The preschool program operates Monday – Friday from 7:00 AM – 6:00 PM. There is an infant program on site, License # 191226432. The preschool program is physically separate from the other components at this facility both indoors and outdoors. There is a waiver on file for sharing of the indoor gymnasium activity area between the infant and preschoolers.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection; Room Humpty Dumpty classroom (2-3 years old): 2 staff with 6 preschoolers in the gym area eating breakfast and Room Rainbow Jack (3-5 years old): 14 preschoolers with 2 staff in gym area eating breakfast. The facility was observed to be within the license capacity and limitations. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. The following was observed during the tour of the facility:
PHYSICAL PLANT
LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment was inspected for age appropriateness and good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials accessible to children were observed to be toxic-free. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. During this inspection at 9:20 a.m. LPA observed one child's backpack and a toy on the floor in the hallway outside Rainbow Jack classroom. Linens are laundered by the facility daily and parents take blankets home each week on Friday or as needed and return it on Monday. Napping equipment (cots) were observed to be stored in a each classroom. Age
REPORT CONTINUES ON NEXT PAGE 1 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
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 6


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: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631
VISIT DATE: 09/12/2022
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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. Per director, children use their own water bottles indoor and outdoor.

Disinfectants, cleaning solutions, medication, and other items that are dangerous to children, were inaccessible to children. Director states there are no poisons stored at the facility. Teacher Brenda Gonzalez-Cortez tested the carbon monoxide detectors in the Rainbow Jack classroom at 9:10 a.m.. It sounded off the alarms and heard by LPA to be functional. LPAs observed required posting information were posted in each classroom and hallway. LPAs did not observe menus to be posted.

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 shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal.

Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. During this inspection LPAs observed outdoor playarea and play structure were dusty, leaves were observed under the play structure and inside the playhouse, black stains were observed on the slide, some water was inside the sink area of the playhouse. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with sand and grass cushioning material that absorbs a fall; climbing apparatuses are single level only. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Per director children take their water bottles outside. LPA advised that no children shall be left without the supervision of a teacher at any time.

The Director states that there are no bodies of water on the premises and LPAs did not observe any bodies of water during this inspection. Director states there are no weapons or firearms on the premises.
FACILITY RECORDS
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.
REPORT CONTINUES ON NEXT PAGE 2 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631
VISIT DATE: 09/12/2022
NARRATIVE
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Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

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



Children's roster was reviewed and is current. 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. LPAs observed sign in/out sheet was placed outside by the entrance door. During this inspection 20 children were present and all 20 children were singed in. Disaster drill log was available, last drill was conducted on 08/18/2022.

Menus were not posted one week in advance where it is visible by the child's authorized representative. Per director due to covid and parents demand this facility does not provide any AM and PM snack to children anymore. Menus for the past 30 days were not available upon request. Snacks were not reviewed for availability, quantity and appropriateness to children in care. Preschoolers bring their own breakfast, lunch, and a PM snack from home. Per director, there is no extra food and snack at the facility. Children bring their own extra food from home.

First Aid supplies were observed in the classroom in a cabinet. According to director, medication is only administered to a child when accompanied with a doctor's note and is stored in the child’s classroom. The facility was observed to be equipped with an isolation area for any child who becomes ill and it is located in the room by the director office. The ill child will use the staff restroom during isolation which is disinfected immediately after use per director. Per director, Public Health Nurse recommended for Covid cases use the children restroom in the hallway by Rainbow Jack classroom and let the child to rest under supervision in the hallway.
REPORT CONTINUES ON NEXT PAGE 3 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631
VISIT DATE: 09/12/2022
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LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an
additional resource. LPA also informed director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Medication: 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. LPA Eivazian asked director to provide Plan of Operation for Incidental Medical Services by 09/30/2022.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.
A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with the director, Morena Duran at 12:20 p.m.
END OF REPORT PAGE 4 OF 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/12/2022 02:37 PM - It Cannot Be Edited

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: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation from outdoor playarea, the licensee did not comply with the section cited above and LPAs observed outdoor playarea was dusty, dried leaves under the play structure and inside the play houses, dirty water was observed in the sink area of the playhouse and black stains were observed on the slide which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Per director, a written plan will be submitted to LPA Eivazian by plan of correction due date 09/30/22 to ensure to keep the outdoor playarea clean and safe for children use.
Type B
Section Cited
CCR
101227(6)
Food Services--Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review and tour of the facility, the licensee did not comply with the section cited above and LPA's did not observe menus to be posted during this inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Per director, facility does not offer any AM/PM snack or food to the children. Enrolled children bring their own breakfast, lunch and PM snack from home. LPA informed director that full day program is required to offer AM and PM snack and half day program is required to offer either AM or PM snack to children. Per director she will create a menu by plan of correction due date and a copy will be submitted to LPA and discussed with parents. Per director she will have some food available in the facility.

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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 09/12/2022 02:37 PM - It Cannot Be Edited

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: SUSANNA WESLEY CHILDREN'S CENTER
FACILITY NUMBER: 191204631

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101223(a)(2)
Personal Rights--To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation during tour of the facility. LPAs observed one child's backpack and a toy on the floor in the hallway at 9:20 a.m. outside of Rainbow Jack classroom, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Per director, children have their own cubbies in each classroom however she will have a communication with all staff to ensure do not put children belongings on the floor anymore.
A written plan will be submitted to LPA by plan of correction due date 09/30/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6