197494347-7-7-2021-30-CC-DLOE-C4PUPV-20210707154610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494347
Report Date: 07/07/2021
Date Signed: 07/07/2021 03:46:25 PM

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:	BRELLA PLAYA VISTA - INFANT		FACILITY NUMBER:	197494347
ADMINISTRATOR:	KENNER RAKOV		FACILITY TYPE:	830
ADDRESS:	12746 JEFFERSON BL #3-3100		TELEPHONE:	(213) 300-5962
CITY:	PLAYA VISTA	STATE: CA	ZIP CODE:	90094
CAPACITY:	10	CENSUS: 5	DATE:	07/07/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	07:35 AM
MET WITH:	Melanie Wolff, Co-Owner		TIME COMPLETED:	03:40 PM

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On 7/07/2021 at 7:35 am, Licensing Program Analysts (LPA), Deborah Lowe and LPA Claudia Escobedo made an announced visit to Brella Playa Vista for the purpose of conducting a pre-licensing visit for a capacity increase. LPA Lowe and LPA Escobedo met with Owner Melanie Wolff. LPA Lowe and LPA Escobedo toured the facility. The facility is requesting an increase to the Infant license with a capacity of 18 infant children from current capacity of 10 infant children.

Co-Owner Darien Williams and Director Kenner Rakoz were present at facility for visit.

An approved fire clearance was conducted with the Los Angeles City Fire Department on 5/25/2021.

Infant Indoor Measurements
Room 7 is the room facility is requesting to add as a second Infant room, (23.25 x 14.25) = 331.31
331.31 divided by 35 sq feet = 9 infants

Infant Outdoor Space: Facility does not have a designated outdoor space for infants.

Restrooms:

Room 7 has a single use restroom observed with 1 toilet, 1 sink, and changing table. Changing table was observed to be within arms distance of the sink.

Infant Indoor activity space
LPA Lowe and LPA Escobedo observed indoor activity space to have age appropriate furniture and toys in good repair, including tables, and chairs.
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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: BRELLA PLAYA VISTA - INFANT	FACILITY NUMBER: 197494347
	VISIT DATE: 07/07/2021

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Fire extinguisher was observed with a service date of 9/12/2019. Facility is equipped with a sprinkler system and fire alarm system. Carbon monoxide and smoke detectors were not observed in facility, Facility stated they have an integrated fire system that includes carbon monoxide and smoke detectors. Facility has central heating and air. First aid kits are stored in each classroom.

Directors office will be used for isolation of ill children. Required postings were observed in front lobby for public viewing. Facility is using an electronic sign in / out program. Parent / guardian sign in using an app called Brightwheel. Facility has a working phone land line available.
Medications are stored in classroom upper cabinet inaccessible to children.
Owner Melanie Wolff stated during visit there will always be 2 staff members in room 7 at all times due to visual limitation with bathroom and distance to refrigerator to access children's food.

Food Service:
Children will bring their own lunch from home and facility will provide prepackaged food parents may purchase if home lunch is not brought. Refrigerator was observed in hallway along with cabinets storage. Refrigerator was observed to be clean and in good working order. Water is provided with the use of a filtered water system, staff fill water pictures and take to classrooms.

Infant Napping/ Crib Space
Children nap in their classrooms. The napping area was observed with 7 cribs and 1 cot for a total of 8 infants in napping area. Napping cribs were observed to be vinyl material. Owner stated cribs and cots are disinfected daily. Facility provides sheets for cribs and cots, Owner stated sheets are cleaned daily. Staff need to physically be in napping area when children are present.

The following was discussed with the applicant:

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.html.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: BRELLA PLAYA VISTA - INFANT	FACILITY NUMBER: 197494347
	VISIT DATE: 07/07/2021

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Required Postings/Licensee shall have posted in the Child Care Center at all times the following:
Facility license.
Personal Rights form (LIC 613A).
Menus.
Child passenger restraint system poster. (PUB 269).
Daily activity schedule.
Emergency Disaster Plan (LIC 610) and Earthquake Preparedness Checklist (LIC 9148) Parent’s Rights Poster (PUB 393).
Notice of Site Visit (LIC 9213).
Any licensing report documenting a type”A” citation must be posted for 30 days.
Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type A deficiency must be posted for 30 days.

Employee/Volunteer Files shall also be maintained and shall contain the following

Health Screening Report - Facility Personnel (LIC 503) and TB Clearance.
Proof of Immunizations
TB Clearance and "Good Health" statement from volunteers.
Personnel Record (LIC 501) or application/resume.
Evaluation of Director Qualifications (LIC 9096).
Evaluation of Teacher Qualifications (LIC 9095).
For each aide under age 18, verification of high school graduation or current participation in an occupational program conducted by an accredited high school or college.
Criminal Record Statement (LIC 508) for staff subject to fingerprint requirements.
Fingerprint clearances - Proof of clearance (Criminal Record, FBI and Child Abuse).
Appropriate driver's license for person(s) transporting children.

Mandated Reporter: Beginning on January 1, 2018, AB 1207, 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.
Website: www.mandatedreporterca.com
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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: BRELLA PLAYA VISTA - INFANT	FACILITY NUMBER: 197494347
	VISIT DATE: 07/07/2021

NARRATIVE

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Senate Bill (SB) 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.

Senate Bill (SB) 277 New Immunization Requirement: 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.

SIDS & SHAKEN BABY SYNDROME INFORMATION: LPA discussed safe sleep for infants with applicant: Infants must be placed on their backs and must be physically checked every 15 minutes to gauge temperature and ensure they are breathing. Applicant reviewed both items provided and understands the guidance of safe sleep practices. LPA discussed flyer given today (Never Shake a Baby) Applicant reviewed flyer and understands the preventive practices of shaken baby syndrome and abusive head trauma.

Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Licensee shall maintain Administrative Records which shall have the following:

Administrative Records
Written inspection procedures for accepting children on a daily basis.
Sign-in/sign-out sheets kept for current 30 days, or approved waiver to use electronic pin system.
Admission policies, including admission criteria, ages of children who will be accepted; medical assessment requirements; program activities, supplemental services, if any; field trip provisions, transportation arrangements, food service, if any.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: BRELLA PLAYA VISTA - INFANT	FACILITY NUMBER: 197494347
	VISIT DATE: 07/07/2021

NARRATIVE

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Designation of Facility Responsibility (LIC 308).
Personnel Report (LIC 500) showing current roster.
Licensee affidavit regarding persons exempt from fingerprint requirements (Use back of LIC 500).
Emergency Disaster Plan (LIC 610) (a posting requirement; see below) with verification that disaster drills are conducted every six months. Documentation of drills shall be maintained for at least one year.Up-to-date list of qualified teacher substitutes.
Documentation of exceptions and waivers: Facility Waiver Request (LIC 956) and Exception/Exemption Request (LIC 971).
Annual licensing reports and substantiated complaints from the last three years (must be available at the center for public review). and a Child Care Facility Roster (LIC 9040).

The applicant was informed 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

Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

California Department of Social Services | Community Care Licensing Division 300 N. Continental Blvd. Suite, 290-A El Segundo, CA 90245

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

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: BRELLA PLAYA VISTA - INFANT	FACILITY NUMBER: 197494347
	VISIT DATE: 07/07/2021

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The following corrections are needed before a capacity increase will be considered:

1. Service fire extinguisher

2. Door to bathroom to access changing table is heavy hard to open, bathroom is also isolated with no opportunity for additional staff to observe. Provide a plan for bathroom usage.

3. IT Closet and Rack Closet doors to remain locked

4. Carpet cleaning - small piece of glass found on carpet.

5. Lights - overhead lights are bright - recommend softer lighting for infants when laying on their backs.

6. Verify that carbon monoxide and smoke detectors are installed at facility.

Upon final administrative review and outstanding corrections needed, final decision of capacity increase License issuance will be determined by the department unit Licensing Program Manager.

Exit interview was conducted with Melanie Wolff, Co-Owner, Darien Williams, Co-Owner and Kenner Rakoz, Director.

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SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021

LIC809 (FAS) - (06/04)

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