191290831-5-18-2022-30-CC-JCHR-CEJUEF-20220518153103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191290831
Report Date: 05/18/2022
Date Signed: 05/18/2022 03:32:01 PM

Document Has Been Signed on 05/18/2022 03:32 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	CHILDREN'S CIRCLE NURSERY SCHOOL		FACILITY NUMBER:	191290831
ADMINISTRATOR:	CRAIG, TIMOTHY J.		FACILITY TYPE:	850
ADDRESS:	6328 WOODMAN AVENUE		TELEPHONE:	(818) 782-9060
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91401
CAPACITY:	44	CENSUS: 31	DATE:	05/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:58 AM
MET WITH:	Timothy Craig-Licensee		TIME COMPLETED:	03:59 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 5/18/2022 Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced *Annual Random/ I year required* visit for the Children's Circle Nursery School. LPA met with Timothy Craig (Licensee/Director) who provided LPA with a tour of the center. LPA observed the following: Care and supervision were observed, upon arrival LPA observed 31 children being supervised by seven staff members. The center was operating within the scope of the license Appropriate size fire extinguisher carbon and smoke detector present & operable throughout the center Detergents, and knives were inaccessible, Toxins were locked and inaccessible. The homes kitchen was clean and sanitized No guns or weapons were present as stated by the Licensee, no weapons observed by LPA Properly working telephone was observed in the directors office LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, Notification of Parent’s Rights Poster, Lead Poison Awareness, and California Safety Seat Law were

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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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Document Has Been Signed on 05/18/2022 03:32 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHILDREN'S CIRCLE NURSERY SCHOOL	FACILITY NUMBER: 191290831
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/18/2022

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which Donna Eastman (pertussis/influenza and Kelly Beech (MMR) did not have complete immunization records on file which poses a potential health risk to persons in care.
	POC Due Date: 06/30/2022
	Plan of Correction
1 2 3 4	Staff members shall provide proof of immunization no later than the due date of 6/30/2022 or sooner as scheduling permits. Copies shall be emailed of mailed to the regional offfice

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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHILDREN'S CIRCLE NURSERY SCHOOL	FACILITY NUMBER: 191290831
	VISIT DATE: 05/18/2022

NARRATIVE

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posted.
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. Licensee’s
At least one person present was current inPediatric CPR and First Aid Card
No bodies of water were observed on the premises
Children records available and in good order.
Personal records were reviewed, files were in good order
All staff had current Mandated Reporter certificates
A roster was readily available current for review.
Parents and authorized adults sign children in and out using their original signatures using an electronic devise, licensee was informed that the devise must be capable of printing a coping of signatures upon request from and authorized enforcement agency for a three year period)
Licensee does not provide Individual Medical Services (IMS). IMS was discussed with licensee.
All staff in the home cleared a Criminal Background Clearance.
Toys, equipment and materials available and in good order Children napped in mats, were found to be in good/fair condition.
Infant safe sleeping was discussed with licensee. LPA reminded licensee that children are only to use car seats during transportation, and appropriate children’s feeding chairs shall only be used during mealtime.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHILDREN'S CIRCLE NURSERY SCHOOL	FACILITY NUMBER: 191290831
	VISIT DATE: 05/18/2022

NARRATIVE

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LPA did not observe any hazardous conditions in the outdoors activity area.
Restrooms were sanitized and in good repair
Parents provide all snacks and meals, food located at the center was properly stored

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.

Licensee 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.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 licensee [facility representative] 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Timothy Craig

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Jillinda Chandler	TELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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