198005652-2-14-2023-54-CC-RNAO-CP322X-20230214160128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005652
Report Date: 02/14/2023
Date Signed: 02/14/2023 04:01:40 PM

Document Has Been Signed on 02/14/2023 04:01 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:	DOLPHIN PARK		FACILITY NUMBER:	198005652
ADMINISTRATOR:	AULAI, LILIU		FACILITY TYPE:	840
ADDRESS:	21205 S. WATER ST.		TELEPHONE:	(310) 549-4560
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	49	CENSUS: 15	DATE:	02/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Lyanne Anniuu		TIME COMPLETED:	04:20 PM

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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced annual required inspection at the above facility on 02/14/2023 at 2:45 PM. LPA met with Facility Representative (FR) Lyanne Anniuu who guided analyst on a tour of the facility. There were 15 children with three staff present when LPA arrived. The program currently operates Monday thru Friday from 2:30am to 6:00pm.

All areas identified on this report were inspected. Upon arrival, the following staff were present during this inspection: Room 1: Staff #1, #2 and #3 with 15 children. Teacher/child ratios were observed to be in accordance with Title 22 Regulations. All children were observed to be under visual supervision of a teacher at all times.

Children's roster was reviewed and is current. Sign in and out sheets were 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. Children present were signed in. Disaster drill log was available, last drill was conducted within six months. LPA observed required licensing documents posted on bulletin board.

Furniture and equipment were inspected for age appropriateness and good repair. LPA observed material and equipment are free of sharp, loose, or pointed parts. Telephone service, heating, lighting and ventilation were evaluated. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. Bathrooms were observed to be gender specific and they provide individual privacy for children. General sanitation was observed.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. According to the Director, no medication is administered. Facility Representative understands that storage areas for poisons must be locked with a key or combination lock. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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: DOLPHIN PARK	FACILITY NUMBER: 198005652
	VISIT DATE: 02/14/2023

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First Aid supplies were observed in the classroom. Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative.The facility provides an afternoon snack that is brought from an outside vendor. LPA observed that children bring their own water in their personal water containers. There is also a purified water fountain available for children to refill their water container.

All kitchen areas/food preparation areas 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, including moveable bins have tight fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

LPA observed that outdoor space is physically separate from all other components. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment, swings and slides have cushioning material to absorb a fall. The outdoor area had adequate shade. LPA did not observe any bodies of water during this visit. Director states there are no weapons or firearms on the premises.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 613A Personal Rights. Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

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

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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: DOLPHIN PARK	FACILITY NUMBER: 198005652
	VISIT DATE: 02/14/2023

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Facility representative 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.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview conducted and report was reviewed with the facility representative Lyanne Anniuu. A notice of site visit was given and must remain posted for 30 days.

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.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul Navarro	TELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC809 (FAS) - (06/04)

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