197419197-7-25-2019-30-CC-MSIN-BEEM5L-20190725091832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419197
Report Date: 07/23/2019
Date Signed: 07/25/2019 09:20:20 AM

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:	A MOTHER GOOSE ACADEMY		FACILITY NUMBER:	197419197
ADMINISTRATOR:	JOHNSON, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	11849 BURBANK BLVD.		TELEPHONE:	(818) 980-0118
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	41	CENSUS: 27	DATE:	07/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Caren Cardenas		TIME COMPLETED:	01:00 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	Margarit Sislyan, Licensing Program Analyst (LPA) met with Caren Cardens, Lead Teacher for a Random visit. LPA Sislyan toured the facility on 7/23/2019. All identified rooms per facility sketch were inspected, and the following was observed. A review of the sign in/out sheet was conducted to verify the current census of children. Currently there are 27 children present. Facility is operating within capacity limitations. Four teachers were present. Classrooms were found to be clean and free from any potential hazards. A record of teacher’s names was checked against current facility roster. Staff is currently associated to the facility. Furniture was found to be in good repair and age appropriate. There is adequate heating, lighting and ventilation. Drinking water is readily available in each classroom. The bathroom areas were inspected. Toilets flush properly. Toilets and sinks are reachable by the children in care. The bathrooms have adequate toilet paper and paper towels available. The bathrooms were found to be clean. There is adequate lighting/ventilation in the bathrooms. School provides Breakfast, Lunch and PM snack for the children in care. Food preparation areas are not accessible to the children in care. Menus are posted. There is adequate food for snacks. The chemicals are kept separate from the food. Trash cans have lids. Refrigerators are clean and operating at the proper temperature. Napping equipment was inspected there is adequate mats and bedding for the children in care, bedding is stored separately. Page 1 of 3

SUPERVISOR'S NAME: Sharon Greene	TELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

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

FACILITY NAME: A MOTHER GOOSE ACADEMY	FACILITY NUMBER: 197419197
	VISIT DATE: 07/23/2019

NARRATIVE

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Inspection of the outdoor play area was conducted. Climbing structures, swings, slides and other large play equipment are found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Drinking water is readily available on the play yard. There is adequate shade for the children in care. Playground is free from miscellaneous debris such as tree branches, trash, leaves, etc.

Children records were reviewed for completeness. Records were found to be complete.

Staff records were reviewed for completeness. Records were found to be complete. (CPR/First Aid expire 3/2020).

For additional information and forms visit our website at: www.ccld.ca.gov

An exit interview conducted.

No deficiencies were cited during this visit. Copy of report provided.

The following were discussed:

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
Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

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SUPERVISOR'S NAME: Sharon Greene	TELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC809 (FAS) - (06/04)

Page: 2 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: A MOTHER GOOSE ACADEMY	FACILITY NUMBER: 197419197
	VISIT DATE: 07/23/2019

NARRATIVE

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New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
Assembly Bill 1207 amended Penal Code Section 11165.7 and amended Health and Safety Code Section 1596.866 and added Health and Safety Code Section 1596.8662.
Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training.
This training requirement may be directly met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/ and are provided in English and Spanish. If no training is made available in a required person’s primary language, then those persons shall be exempt from this requirement.

Exit Interview Conducted

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SUPERVISOR'S NAME: Sharon Greene	TELEPHONE: (424) 302-3048
LICENSING EVALUATOR NAME: Margarit Sislyan	TELEPHONE: ((42) 430-3049
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3