191599892-9-7-2023-33-CC-CTUA-CVFR3R-20230907124024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191599892
Report Date: 09/07/2023
Date Signed: 09/07/2023 12:41:33 PM

Document Has Been Signed on 09/07/2023 12:41 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:	WING LANE ELEMENTARY		FACILITY NUMBER:	191599892
ADMINISTRATOR:	M. YOKOYAMA, R. KHANNA		FACILITY TYPE:	850
ADDRESS:	16605 WING LANE		TELEPHONE:	(626) 933-5937
CITY:	VALINDA	STATE: CA	ZIP CODE:	91744
CAPACITY:	24	CENSUS: 15	DATE:	09/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Delia Castro & Kathy Jarvey		TIME COMPLETED:	12:45 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 September 7, 2023, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced required 1-year inspection. A COVID-19 risk assessment was conducted prior to entering the facility. LPA entered facility through the Wing Lane elementary school’s front office and walked towards the back of the school to enter through a gate into the preschool program. LPA met with teacher, Delia Castro and LPA took a census of 15 children and 3 staff in care. The preschool program operates as a Head Start preschool program. LPA called and spoke to the main office that is located off-site. At approximately 10:15 am Site Supervisor, Kathy Jarvey who oversees the preschool program met with LPA to facilitate the visit. Hours of operation: The days and hours of operation for Wing Lane Head Start: Monday-Friday, 8:00 A.M.-2:00 P.M. Location: There is only one portable licensed (Head Start HV-1) but there are two portables on site. The other portable is being used as storage but according to Site Supervisor they are planning to rebuild a new portable and have the Department license it in the near future. The portables are located on the north side of Wing Lane Elementary. The portables and the playground is completely surrounded by a chain-link fence, separating them from the rest of the elementary school. The portable is one large classroom with a restroom for the children, one staff restroom, a kitchenette, and one office for the staff. To gain access to the school there is a side gate for parents to drop-off and pick-up children. All posting requirements were observed on the Parent Board which is located on the wall adjacent to the door through which the children will enter. There is a copy of the monthly menu which is posted outside on a small board and menus are available on the website and emailed to parents. All food is provided by the School District. There is breakfast served at 8:00 am, lunch at 11:00 am and P.M. snack at 1:30 pm. page 1 of 3

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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: WING LANE ELEMENTARY	FACILITY NUMBER: 191599892
	VISIT DATE: 09/07/2023

NARRATIVE

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Portable has a kitchenette area which contains a full-size refrigerator. There is currently one child who requires medication which is currently stored in a locked cupboard up high in the kitchenette area out of reach of children. LPA observed medication which is not expired and required paperwork was stored with the medication. Portable has a First Aid Kit in the kitchen cabinet which is labeled with a sign. Cleaning supplies are kept in the cabinet under the kitchen sink in the kitchenette; it is locked with a chain and a padlock.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

There is a carbon monoxide and smoke detectors that are connected to the elementary school and are tested by the school district through-out the year. The last annual maintenance on the Fire Extinguisher was on August 8, 2023. Fire Drill was last conducted and documented on September 1, 2023.

LPA reviewed parent sign-in/out sheets and found that they are recording time of drop-off and pick-up and using full signature for children in care.

The children's restrooms have two toilets, and 2 child-size sinks which are located inside the restrooms. There is also a small sink with drinking fountain attached located outside of the children’s restroom. According to Site Supervisor they use a Brita filtered drinking water jug that is filled up from the water source in the kitchenette with disposal cups. Children are not currently using the water fountain. The adult restroom will be used by staff. Children currently nap and there is napping equipment stored in the classroom and cots are sanitized each day. The children bring napping items from home and are sent back at the end of the week.

LPA referred Site Supervisor to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPA consulted with Site Supervisor regarding the PIN 21-21.1-CCP for written directives of Lead Testing.
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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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: WING LANE ELEMENTARY	FACILITY NUMBER: 191599892
	VISIT DATE: 09/07/2023

NARRATIVE

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LPA reviewed staff and children files and found that all necessary documentation was present.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Site Supervisor was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

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

Exit interview conducted and report was reviewed with the Site Supervisor, Kathy Jarvey.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 09/07/2023 12:41 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: WING LANE ELEMENTARY	FACILITY NUMBER: 191599892
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above and facility has not been lead tested since 2019 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/09/2023
	Plan of Correction
1 2 3 4	Per Site Supervisor, facility will test water outlets (Kitchen and water fountain).

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: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn Tuba	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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