191601006-11-16-2022-54-CC-MAYA-CL8RQE-20221116121324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191601006
Report Date: 11/16/2022
Date Signed: 11/16/2022 12:13:39 PM

Document Has Been Signed on 11/16/2022 12:13 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	M A W CHILDREN'S CTR		FACILITY NUMBER:	191601006
ADMINISTRATOR:	SUSAN ROWE		FACILITY TYPE:	850
ADDRESS:	5510 CLARK AVE		TELEPHONE:	(562) 867-4083
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	56	CENSUS: 36	DATE:	11/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director, Shelia Palmer		TIME COMPLETED:	12:30 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 November 16, 2022 at 9:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Director, Shelia Palmer. The purpose of the inspection was to conduct the Required 1 Year inspection at the facility. Entrance Checklist – Child Care Centers (LIC 125) was provided to the Director upon arrival. The facility is located inside Burns Community Center (city building). Per Director, the program operates Monday through Friday from 6:00 am to 5:30 pm. The Director guided LPA on a tour of the inside and outside of the facility. All areas on the facility sketch were inspected. The facility currently utilizes 3 classrooms that are divided by partitions; Room 2, Room 3 and Room 4. Upon arrival, the following staff were present: Staff (S1) and S2 inside Room 2 with 12 preschool children, S3 and S4 inside Room 3 with 14 preschool children, and S5 inside Room 4 with 10 preschool children. The following documents are posted in a prominent, publicly accessible area: Facility License, Menu, Child Passenger Restraint System Poster (PUB 269), Notification of Parents' Rights (LIC 393), Emergency Disaster Plan (LIC 610), Personal Rights (LIC 613A), and Daily Activity Schedule. Children's roster was reviewed and is current. Sign-in and sign-out sheets were reviewed; all children present were signed in. Per Director, transportation is not provided by the program. Per Director, bedding is taken home on a weekly basis to be washed. According to the Director, medication is only administered to a child when accompanied with a doctor's note and medication is stored in the kitchen. At this time, no children enrolled in care require any medication.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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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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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: M A W CHILDREN'S CTR	FACILITY NUMBER: 191601006
	VISIT DATE: 11/16/2022

NARRATIVE

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Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed napping equipment (cots) and cubbies inside each classroom. Per Director, the isolation area is in the office or staff lounge. In the office or staff lounge, a cot can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair. General sanitation was observed. Availability of indoor and outdoor drinking water was observed (water fountains).

Per building management for Burns Community Center, the carbon monoxide detector is in combination with the wired smoke detectors inside the building. The carbon monoxide detector and smoke detector were not tested due to being wired to the emergency pull down system. The fire extinguishers are fully charged and were last serviced on July 11, 2022. The facility has verification of disaster and fire drills available for review. However, the last drill was conducted on October 8, 2021. First Aid supplies were observed and kept inside each of the children's restrooms.

Disinfectants, cleaning solutions, and other items that are hazardous to children, were made inaccessible to children in all areas. Director confirmed that there are no poisons stored at the facility. All kitchen, food preparation 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 have tight-fitting covers that are kept on and in good repair. LPA observed electrical outlet covers installed in all child care areas.

Outdoor playground equipment is in a safe condition, free of sharp, lose 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, slides, and similar equipment are cushioned with sand that could absorb a fall. Per Director, the sand is inspected daily prior to use. LPA observed adequate shade in the outdoor play yard. No bodies of water was observed on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: M A W CHILDREN'S CTR	FACILITY NUMBER: 191601006
	VISIT DATE: 11/16/2022

NARRATIVE

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LPA conducted a record review of 5 children’s records and 6 personnel records for completeness. Based on the record reviews, all children's records have the required documents per licensing regulations. LPA found that Staff (S3) did not have a Health Screening Report (LIC 503) available for review. LPA also found that S5 did not have immunization records for pertussis, measles and influenza (or documentation of exemptions); TB clearance, and a valid Mandated Reporter (AB 1207) certificate of completion available for review. During the inspection, there was at least one staff present with a valid Pediatric First Aid and CPR certification. The names of children and staff whose records were reviewed were documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 Director on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at: www.ccld.ca.gov.

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.

Deficiencies were cited during today's inspection (refer to deficiency pages). During the inspection, LPA also advised the Director that the annual licensing fees are not current and requested that proof of payment for the outstanding balance be submitted to LPA via e-mail.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Director, Shelia Palmer.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/16/2022 12:13 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: M A W CHILDREN'S CTR	FACILITY NUMBER: 191601006
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2022

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 1 personnel record (S5) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Director will submit the immunization record (pertussis, measles and influenza or documentation of exemption) for Staff (S5) to LPA via e-mail by 12/16/2022.

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 1 personnel record (S5) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Director will submit a valid Mandated Reporter (AB1207) certificate of completion for Staff (S5) to LPA via e-mail by 12/16/2022.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 11/16/2022 12:13 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: M A W CHILDREN'S CTR	FACILITY NUMBER: 191601006
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. 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 1 personnel record (S3) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Director will submit the completed Health Screening Report (LIC 503) for Staff (S3) to LPA via e-mail by 12/16/2022.

Type B

Section Cited

CCR

101217(a)(12)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g). 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 1 personnel record (S5) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/16/2022
	Plan of Correction
1 2 3 4	Director will submit a current TB clearance or risk assessment for Staff (S5) to LPA via e-mail by 12/16/2022.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC809 (FAS) - (06/04)

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