191226432-9-12-2022-33-CC-AEIN-CJ7TB6-20220912143437

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191226432
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:35:33 PM

Document Has Been Signed on 09/12/2022 02:35 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 CTR/INFANT		FACILITY NUMBER:	191226432
ADMINISTRATOR:	MORENA DURAN		FACILITY TYPE:	830
ADDRESS:	134 N. KENWOOD ST.		TELEPHONE:	(818) 548-6229
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91206
CAPACITY:	19	CENSUS: 15	DATE:	09/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Morena Duran, Director		TIME COMPLETED:	03:00 PM

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Licensing Program Analysts (LPA) Anomeh Eivazian and Enjoli Maeweather conducted an unannounced annual inspection on 09/12/2022 at 12:20 PM. LPAs met with Morena Duran, director who guided LPAs on a tour of the facility . LPA Eivazian provided Morena Duran, director with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). This is an infant program located at the First United Methodist Church of Glendale property. The infant program consists of two classroom, RM Ducklings (6 weeks- 12 months old) and RM Monkeys (12-24 months old). The infant program operates Monday – Friday from 7:00 AM – 6:00 PM. There is a preschool program on site, License # 191204631. The infant 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. The following staff were present during this inspection: RM Ducklings: 1 staff with an infant in the classroom and 1 staff with 3 infants in the crib room, RM Monkeys: 1 staff with 11 napping infants. The following was observed during the tour of facility:

PHYSICAL PLANT

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Director staff there are no poison on the premises. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All toilets and hand washing facilities are safe, sanitary and are operating properly. All floors are clean and safe. LPAs observed a changing table in Duckling classroom. Children have their own cubby to store their belongings. 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.
All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish and 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. Drinking water is readily available both indoors and outdoors. The facility was observed to be free of flies, other insects and rodents.

REPORT CONTINUES ON THE NEXT PAGE 1 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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: SUSANNA WESLEY CHILDREN'S CTR/INFANT	FACILITY NUMBER: 191226432
	VISIT DATE: 09/12/2022

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Infant Outdoor playarea is located at the other side of the Church building in the corner of Broadway and Kenwood. There is a waiver on file to escort the infants to outdoor yard area via sidewalk or church walkaway only. Per director, infants are transported via strollers via sidewalk to the outdoor playarea. 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. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with artificial grass that absorbs a fall. There is adequate shade in the play yard.

INFANT PROGRAM (in addition to general compliance)
Infant changing tables have a padded surface no less than one inch thick and are covered with washable vinyl or plastic and have raised sides at least three inches high. Per director, teacher use the changing table inside the Duckling classroom and if it is needed the changing table in the preschool bathroom. Waiver on file. Toys were observed to be clean and safe. Infant napping equipment meets the requirements of 101439.1 (a) - (f). Indoor activity space for this infant program is physically separate from the other components at this facility, and meets the requirements of 101438.3 (a) - (e).

The facility is in compliance with the staff-infant ratios required in 101416.5 (a) - (e). A fully qualified teacher is directly supervising no more than 12 infants. Each aide is responsible for the direct care and supervision of a group of no more than four infants. Individual Feeding Plans are on file for each infant that meets the requirements of 101427 (b)(1) - (5). Infant Needs and Services Plan are on file for each infant that meets the requirements of 101419.2 (a)-(b) and 101419.3 (a). Teachers present have proof of the required infant units on file and meet the qualification requirements of 101416.2 (a), (b), (c) and (g).

FACILITY RECORDS
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. LPA observed sign in/out sheet was placed outside by the entrance door. During this inspection 15 infants were present and all 15 infants were singed in. Disaster drill log was available, last drill was conducted on 08/18/2022.
Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (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 CTR/INFANT	FACILITY NUMBER: 191226432
	VISIT DATE: 09/12/2022

NARRATIVE

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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.

LPA observed operable carbon monoxide detector in each classroom.

Menus were not posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days were not available upon request. Snacks were not available during this inspection. Per director, infants bring their own food and milk from home. Currently, the facility does not provide AM and PM snack.

The facility shall ensure that each infant is never left unattended, and is under the direct visual supervision of a staff person at all times.

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. Per director, currently there is no children enrolled to provide IMS. LPA asked director to submitted Plan of Operation for Incident Medical Services ( IMS) by 09/30/22.

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 staff office. The ill child will use the staff restroom during isolation which is disinfected immediately after use per Site Supervisor.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (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 CTR/INFANT	FACILITY NUMBER: 191226432
	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.
INFANT CARE: During this inspection LPA observed 3 infants napping in crib room, 11 infants napping on cots in the Monkeys classroom, and 1 infant was with a teacher in Ducklings classroom. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant under 12 months old in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space in crib room, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the director that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
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.
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 experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with licensee (or facility representative) including name.

REPORT END 4 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (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 5

Document Has Been Signed on 09/12/2022 02:35 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 CTR/INFANT	FACILITY NUMBER: 191226432
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/12/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101227(a)(1)

Food Services

(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation and director statement, the licensee did not comply with the section cited above and facility does not provide AM/PM snack to children and menus were not available to review 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
1 2 3 4	Per director, she will have a menu ready by plan of correction due date 09/30/22 and share it with parents. Facility will offer optional AM/PM snack to infants from now on. Per director, she will have some age appropriate snacks available at the facility. A written plan will be submitted to LPA by plan of correction due date 09/30/22.

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: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh Eivazian	TELEPHONE: (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)

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