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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224480
Report Date: 05/29/2019
Date Signed: 05/29/2019 02:30:52 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:LA CANADA UNITED METHODIST CHILDREN'S CENTERFACILITY NUMBER:
191224480
ADMINISTRATOR:BLANCA RODRIGUEZFACILITY TYPE:
850
ADDRESS:104 BERKSHIRE PLACETELEPHONE:
(818) 790-2871
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY:35CENSUS: DATE:
05/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Blanca RodriguezTIME COMPLETED:
02:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Justin Dorsey conducted an unannounced Annual Inspection. LPA met with Blanca Rodriguez, Director, who guided LPA on a tour of the facility. During the inspection there were 29 children present in four classrooms (Tigers, Bears, Ducklings and Turtles classrooms).

LPA inspected all areas identified on the Facility Sketch. The following staff were observed in each classroom during this visit: Tigers: Staff #1 with 11 children; Ducklings: Staff #2 with 6 children; Turtles: Staff #3 with 4 children and Bears: Staff #4 with 8 children. The facility is broken up in two different buildings. The building closest to the parking lot holds the Tiger classroom, extra curricular classroom and a restroom for children. The building furthest from the parking lot holds the Bears, Ducklings and Turtles classrooms, kitchen and restroom for the children. Students have access to the classrooms, restrooms and outdoor play area. The 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 in each building (teachers are paged from the main office), heating, lighting and ventilation available at the facility. The main office has been designated as the isolation room and the teachers restroom has been designated for use of ill children.

Drinking water is available indoors and outdoors. Restrooms used were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation.

The kitchen is inaccessible to children and behind a closed door. The facility provides morning and afternoon snack, lunch is brought by the parents. Snack menus were posted in the kitchen. Snacks were reviewed for availability, quantity and appropriateness to children in care. Poisons are locked in a cabinet (under the kitchen sink). Cleaning compounds and sharp items are inaccessible. Containers used to discard food have tight fitting lids at this time.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LA CANADA UNITED METHODIST CHILDREN'S CENTER
FACILITY NUMBER: 191224480
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/12/2019
Section Cited
CCR
101174(d)(2)
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101174 Disaster and Mass Casualty Plan (d)(2) Disaster drills shall be conducted at least every six months. The drills shall be documented. This documentation shall be kept in the child care center for at least one year. This is not met as evidenced by:
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Facility will conduct and document disaster drills every six months. The Director will conduct a disaster drill (fire and earthquake) and send LPA a copy of the documentation.
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Based on observation the facility does not have documentation of a fire drill since 10/15/15 or an earthquake drill since 10/19/17, which poses a 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: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LA CANADA UNITED METHODIST CHILDREN'S CENTER
FACILITY NUMBER: 191224480
VISIT DATE: 05/29/2019
NARRATIVE
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Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The play area has benches with umbrellas as well as a shade sail to provide shade. 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 other equipment are cushioned with material (turf, padding and wood chips). 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 12/2019). Staff has met all immunization requirements. First Aid supplies are available.

On 05/29/19 at 1:40pm LPA Justin Dorsey found that the facility had no documentation of a fire drill since 10/15/15 or an earthquake drill since 10/19/17. Director Blanca Rodriguez told LPA that the facility has conducted the drill in the past six months but has not documented them.

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.

Exit interview was conducted with Director Blanca Rodriguez, Appeal Rights were given.

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

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3