197493784-6-6-2019-30-CC-MJVZ-BCVPP3-20190606112852

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493784
Report Date: 06/06/2019
Date Signed: 06/06/2019 11:29:04 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:	KID'S CLUB PROGRAMS		FACILITY NUMBER:	197493784
ADMINISTRATOR:	ROBERTS, TONY		FACILITY TYPE:	840
ADDRESS:	23838 KITTRIDGE STREET		TELEPHONE:	(818) 591-2582
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	30	CENSUS: 0	DATE:	06/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Tony Roberts, Licensee		TIME COMPLETED:	11:58 AM

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) Martha Vasquez met with Tony Roberts, Licensee to conduct an unannounced Annual/Random and Increase of Capacity inspection to the aforementioned facility. This facility is located on the Shepherd of the Valley Church premises. The facility is housed in two separate buildings and utilizing 3 classrooms. The Licensee has submitted an application to increase the facility from 30 school age children to 52 school age children. Please note, the facility will no longer be utilizing Classroom 3 as it is now licensed to the preschool on campus, LIC #197414470. The facility will now utilize Classroom 1, Classroom 2, and Classroom 6. Measurements were taken during the inspection and were observed for a total indoor and outdoor capacity of 59 children. Licensee also submitted a waiver for shared usage of the playground and bathroom areas during the inspection which included both preschool and school-age outdoor schedule. Please note, the waiver has already been approved on the preschool license. The following were observed/discussed during this inspection: 1. There are no bodies of water observed on the facility; 2. Fingerprint clearance of staff; 3. Teacher to child ratios; 3. Care and supervision of children in care; teacher/child interaction; 4. Availability of drinking water to children both indoors and outdoor; there are water fountains in the playground areas. 5. Cleanliness of facility and children's toys/equipment; age appropriateness of the children's toys and equipment. 6. Cleanliness of bathrooms, operation of toilets and sinks. 7. Inaccessibility of chemicals and toxins to children in care; (Continued)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

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: KID'S CLUB PROGRAMS	FACILITY NUMBER: 197493784
	VISIT DATE: 06/06/2019

NARRATIVE

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8. Quality and quantity of snacks and food for the number of children currently enrolled; storage of food supplies, posting of menus and accuracy.
9. Smoke detector and carbon monoxide detector.
10. Sign in/out sheets; postings; emergency disaster drill logs.

At this time the facility does not provide Incidental Medical Services.

The following was thoroughly discussed with the licensee:
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

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations. (Continued)

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

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: KID'S CLUB PROGRAMS	FACILITY NUMBER: 197493784
	VISIT DATE: 06/06/2019

NARRATIVE

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Increase of capacity for a total capacity of 52 school-age children is granted effective today 06/06/2019 as requested by Tony Roberts, Licensee. A provisional license will be granted today for 30 days and a regular license will be issued once the Department decides on the licensee's request for a waiver of shared usage of the playground and bathroom between the preschool and school-age program. An exit interview was conducted and copy of this report was provided to Tony Roberts, Licensee.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Martha J Vasquez	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019

LIC809 (FAS) - (06/04)

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