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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597028
Report Date: 12/17/2019
Date Signed: 12/17/2019 04:30:24 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:BARNES PARK EXTENDED DAY CAREFACILITY NUMBER:
191597028
ADMINISTRATOR:VAZQUEZ, MARISELAFACILITY TYPE:
840
ADDRESS:350 S. MCPHERRIN AVE.TELEPHONE:
(626) 307-1451
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:40CENSUS: 3DATE:
12/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Marisela Vazquez, Daycare CoordinatorTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced annual random required inspection. LPA met with Marisela Vazquez, Daycare Coordinator, who guided analyst on a tour of the facility. Upon LPA arrival, there were no children present. There are currently 24 children enrolled in program.

This is an extended day care program which is a shared building located on the premises of Barnes Park. The facility consists of one classroom; RM 3, kitchen, isolation room, office, gym, girl’s and boy’s restroom and outdoor patio (fenced). Facility operation hours are Monday’s, Tuesday’s, Wednesday’s and Friday’s from 1:30 PM to 7:00 PM and on Thursday’s from 11:30 AM to 7:00 PM. The program hours are Monday’s, Tuesday’s, Wednesday’s and Friday’s from 2:00 PM to 7:00 PM and on Thursday’s from 12 Noon to 7:00 PM.

All areas identified on the Facility Sketch were inspected. During the walk through the following staff were observed present during this inspection: Room 3: Staff #1 with 3 school-agers. The following was observed during the tour of the facility:

PHYSICAL PLANT


Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Per Daycare Coordinator, the isolation area is located in the isolation office. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. LPA observed that the facility does have a dual smoke and carbon monoxide detector which was tested and it is in operable condition. Availability of indoor drinking water was observed in classroom.

REPORT CONTINUES ON THE NEXT PAGE 1 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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 4
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: BARNES PARK EXTENDED DAY CARE
FACILITY NUMBER: 191597028
VISIT DATE: 12/17/2019
NARRATIVE
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Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Daycare Coordinator states that poisons are locked in the kitchen cabinet.

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.

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. Availability of outdoor drinking water was observed.

FACILITY RECORDS

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed for completeness; Inspection of required forms was made. LPA issued the Children’s Record Review (LIC 857) to the Daycare Coordinator during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

LPA also issued the Review of Staff records (LIC 859) to the Daycare Coordinator during this inspection. The LIC 857 and the LIC 859 documents the staff and children’s files that were reviewed during this inspection.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 10/7/2019.

REPORT CONTINUES ON THE NEXT PAGE 2 OF 3

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: BARNES PARK EXTENDED DAY CARE
FACILITY NUMBER: 191597028
VISIT DATE: 12/17/2019
NARRATIVE
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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. The facility provides PM snack.

First Aid supplies were observed in the classroom in a cabinet. According to Daycare Coordinator, medication is only administered to a child when accompanied with a doctor's note and is stored in a locked cabinet inside the isolation room. In review of stored medication, LPA observed that the epinephrine for child #1 expired with an expiration date of 12/2018 (photo was taken) and expired albuterol for child #1 was also stored with an expiration date of 08/2019 (photo was taken).

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

LPA advised the Daycare Coordinator to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Daycare Coordinator, Marisela Vazquez, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. REPORT END-PAGE 3 OF 3----

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: BARNES PARK EXTENDED DAY CARE
FACILITY NUMBER: 191597028
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2019
Section Cited

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101226-Health-Related Services: (3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.
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This requirement is not met as evidenced by LPAs observation that the epinephrine for child #1 expired with an expiration date of 12/2018 and expired albuterol for child #1 was also stored with an expiration date of 08/2019 (photo was taken). This poses a potential health and safety 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4