198004154-10-10-2019-33-CC-CGRN-BGTRKY-20191010130619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004154
Report Date: 10/10/2019
Date Signed: 10/10/2019 01:06:34 PM

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:	WOODBURY VILLAGE, INC.-INFANT CENTER		FACILITY NUMBER:	198004154
ADMINISTRATOR:	DANIELLE SVIHOVEC-MESQUITA		FACILITY TYPE:	830
ADDRESS:	712 W. MT. VIEW ST.		TELEPHONE:	(626) 794-3211
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	41	CENSUS: 30	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Danielle Svihovec- Mesquita		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Crystal Green conducted an unannounced annual inspection. Upon arrival, LPA met with Danielle Svihovec- Mesquita, Director. LPA was guided on a tour of the facility. This is an infant program licensed for 26 infants ages 0 – 2 years with a toddler option licensed to serve 15 toddlers ages 18- 36 months. The facility operates Monday – Friday from 7:00 AM – 6:00 PM. During the tour LPA observed that there was a preschool located on the premises with facility number 198004153 that is physically separate from the infant center both indoors and outdoors. This Infant Center consists of 3 classrooms, Pandas (0- 12 months), Koalas (12- 24 months), and Roos (18- 36 months). The following was observed during this visit. In Pandas classroom, LPA observed (7) infants with (5) staff members. In the Koalas classroom, LPA observed (11) infants with (5) staff members. In the Roos classroom, LPA observed (12) toddlers with (4) staff members. All children were observed by LPA to be under visual supervision of a teacher at all times. The Licensee is within the conditions, limitations, and capacity specified on the license. Sign in and out sheets was reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. At this time, the office is used as an isolation area. There is a portable infant crib and changing table located in the office. Parents are contacted immediately when children are determined to be ill. Furniture and equipment were inspected for age appropriateness. All changing tables and feeding chairs are in operational condition. There is a sink with hot water within arm’s reach of each of the changing table located in each classroom. Indoor classroom was inspected to ensure that the floors have a surface that is safe and clean. Infants used personal drinking bottles for water. LPA observed in the Koalas and Roos drinking water containers with cups readily accessible. Report Continues on Page 1 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: WOODBURY VILLAGE, INC.-INFANT CENTER	FACILITY NUMBER: 198004154
	VISIT DATE: 10/10/2019

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
26
27
28
29
30
31
32

Facility provides AM and PM snacks. Parents provide lunch and are already prepared when they are brought to the facility. LPA observed that all food brought from home contains the child name on the outside and is protected from contamination. Lunch bags are stored in the refrigerator. Food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Infant formula is provided by parents; however, formula is available at the facility if needed. There are bottle warmers and refrigerator is available. All storage containers for solid waste, including moveable bins, have tight fitting covers. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to infants.

Outdoor playground equipment was observed to be in a safe condition. All areas around or under high climbing equipment and slides shall be cushioned with material that absorbs a fall. There is adequate shade in the play yard. LPA observed sippy cups are taken outdoors. Outdoor playground equipment was observed to be in a safe condition.

This facility already offers Incidental Medial Services (IMS) to children that require it. Policy for IMS services already on file per Director. Staff Records was reviewed to ensure that Infant Teacher present are qualified with Criminal Records Clearance and verification of CPR/First Aid. Children’s Records were reviewed to ensure that Identification and Emergency form and a Needs and Services Plan are on file.

No deficiencies are being cited in accordance with California Code of Regulations Title 22.

Exit interview was conducted with Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report Ends Page 2 of 2.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2