191500469-5-29-2019-33-CC-SLEE-BCN27V-20190529170923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191500469
Report Date: 05/29/2019
Date Signed: 05/29/2019 05:09:29 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:	MARYVALE DAY CARE CENTER		FACILITY NUMBER:	191500469
ADMINISTRATOR:	JESSICA LIRA		FACILITY TYPE:	850
ADDRESS:	7600 EAST GRAVES AVENUE		TELEPHONE:	(626) 280-6510
CITY:	ROSEMEAD	STATE: CA	ZIP CODE:	91770
CAPACITY:	60	CENSUS: 0	DATE:	05/29/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Yesenia Arteaga		TIME COMPLETED:	05:15 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	Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Assistant Director Yesenia Arteaga. It was reported to the Department on 04/01/2019 that Child#1 was left in the restroom for about 3-4 minutes without supervision. This occurred around 4:30PM on 04/01/2019, reporting requirements were met. It was stated that child#1 was escorted the restroom by Staff#2 along with other children. While Staff#2 was in the restroom with the children, Staff#1 entered the restroom with one child. Staff#1 was asked to relieve Staff#2 and watch over the children which included Child#1. However, while escorting all the children back outside from the restroom, Child#1 was left in one of the stalls in the restroom until she was discovered by Staff#3 who was the lead teacher at the time 3-4 minutes later. Although Staff#1 did not bring the child to the restroom originally, the child should have been accounted for had Staff#1 followed facility policy in regards to checking children during restroom time. Staff#1 was placed on administrative leave on 04/02/2019 and was in the process of being terminated for not following facility procedure. Staff#2 received a written disciplinary action from the facility for also not following policy in regards to transition procedures. On 04/03/2019 Staff#1 resigned from her position as teacher. Documentation of the actions taken by the facility and staff were obtained during the inspection by LPA Lee. Since the incident, the facility has provided supplementary training for all staff members at the facility in regards to supervision and transition procedures. Copies of the sign in sheet for training were obtained. The restroom used during outside play has also been modified to include a white board. The white board is now used to list the names of children brought into the restroom by a Staff member to making accounting for children more accurate.

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
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: MARYVALE DAY CARE CENTER	FACILITY NUMBER: 191500469
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/29/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/30/2019 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). Child#1 was left in the restroom for about 3-4 minutes on 04/01/2019. This is an immediate	1 2 3 4 5 6 7	The facility has provided supplemental training for all staff members in regards to supervision and transition during restroom time. Staff#1 was placed on leave and resigned before she was terminated. Staff#2 was given a written diciplinary action for the incident. Restroom has been modifed with a white board to make accounting for children more accurate.
	8 9 10 11 12 13 14	risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
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: MARYVALE DAY CARE CENTER	FACILITY NUMBER: 191500469
	VISIT DATE: 05/29/2019

NARRATIVE

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The parent of Child#1 was notified of the incident through telephone and a written ouch report. The child still attends the facility per Assistant Director.

The information obtained during this inspection is enough to determine that title 22 regulations were violated by the facility in regards to the incident that occurred on 04/01/2019. Please see the attached 809D page.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain notice during business hours will result in a civil penalty of $100.00 dollars. A copy of this report shall also be posted along with the notice of site inspection. All 3 pages of this report shall be posted individually for 30 days. The facility will obtain parent signatures from parents on the LIC 9224 form. Each form with the parent signature shall be placed in the files of all children enrolled at the facility and all incoming children for the next year.

Exit interview conducted with Assistant Director Yesenia Arteaga. Appeal rights discussed and explained.

SUPERVISOR'S NAME: Guangorena Claudia	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung Lee	TELEPHONE: (323) 981-3382
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)

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