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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290357
Report Date: 06/14/2022
Date Signed: 06/14/2022 02:27:15 PM


Document Has Been Signed on 06/14/2022 02:27 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:GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.FACILITY NUMBER:
191290357
ADMINISTRATOR:MULLICH, ROXANNEFACILITY TYPE:
850
ADDRESS:1130 RUBERTA AVETELEPHONE:
(818) 243-1088
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:68CENSUS: 24DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Roxanne Mullich, DirectorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection on 06/14/2022 at 10:50 AM. LPA met with Roxanne Mullich, Director. LPA provided with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). Director guided LPA on a tour of the facility. This is a preschool program located in the Grandview Presbyterian Church. The preschool program operates Monday – Friday from 7:30 AM – 5:00 PM. This is a preschool program which consists of 4 classrooms; RM PreK Busy Bees (4-5 years old) which is located next to office, Lady Bug Loft (3-4.5 years old) is located in the Church building in second floor, and Caterpillars (2-3 years old) located next to Lady Bug Loft in the Church Building, and Butterfly classroom in the first floor of Church building which is empty and not in use currently.

All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: 8 preschoolers from Caterpillar classroom with 1 staff were playing on sand playground. 7 preschoolers with 1 staff in room Busy Bees, and 9 preschoolers with 1 staff in Ladybug Loft classroom. There is a gym in the first floor of Church building which is used as multi purpose room and Fellowship Hall in Church building which is use as nap room by Lady Bug Loft preschoolers. Per Director, Busy Bess parents enter the facility through the Ruberta Ave entrance gate and Lady Bug and Caterpillar children are dropped of at 5th street Church entrance gate. 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.
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: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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: GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.
FACILITY NUMBER: 191290357
VISIT DATE: 06/14/2022
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Parents take Linens home each week on Friday or as needed and return it on Monday. Napping equipment (cots) were observed to be stored in the classroom. Age 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, cleaning crew come and clean the facility daily after hours.

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. Director tested the carbon monoxide detectors in the office. It sounded off the alarms and heard by LPA to be functional.

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. 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, swings, slides, and similar equipment are cushioned with sand 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. LPA observed water container and disposable cups during outdoor activity time. 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 LPA 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: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 2 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: GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.
FACILITY NUMBER: 191290357
VISIT DATE: 06/14/2022
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 #2 and staff #3 did not have proof of the AB 1207 Mandated Reporter Training certificate on file. LPA reviewed four staff file and staff #2 and staff #3 did not have proof against 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. LPA observed sign in/out sheet was placed outside by the entrance doors. During this inspection 24 children were present and 22 children were singed in. Disaster drill log was available, last drill was conducted on 05/26/2022.



Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. Preschoolers are provided AM and PM snack, and children bring their own lunch 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 office. 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.

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.
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: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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: GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.
FACILITY NUMBER: 191290357
VISIT DATE: 06/14/2022
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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. Plan of Operation was submitted on 06/19/2017. Per director currently they do not have any children enrolled to administer IMS.

LPA provided the director with a copy of the Effects of Lead Exposure form during the inspection and discussed the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

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, Roxanna Mullich at 2:50 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: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 06/14/2022 02:27 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: GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.
FACILITY NUMBER: 191290357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on 4 staff file reviews, the facility did not comply with the section cited above in 2 out of 4 staff did not have required proof of immunization against pertussis and measles on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per director, staff#2 and staff#3 will complete and submit their proof of immunization against pertussis and measles by plan of correction due date, 07/15/2022 and copies will be submitted to LPA via email.
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
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Based on 4 staff file reviews, the facility did not comply with the section cited above and staff #2 and staff#3 did not have required current mandated reporter training certificates on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per director, staff#2 and staff#3 will complete required mandated reporter training by plan of correction due date, 07/15/22 and copies will be submitted to LPA via email.

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: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 06/14/2022 02:27 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: GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.
FACILITY NUMBER: 191290357

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA sign in/out sheet review, the facility did not comply with the section cited above. During this inspection 24 children were present and only 22 children were signed in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/15/2022
Plan of Correction
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Per director, a written notification will be sent out to all parents to remind them to sign in/out children daily. A copy of written note will be submitted to LPA by Plan of Correction due date 07/15/22 as plan of correction.
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: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6