198015695-9-5-2019-33-CC-ABAY-BFQLPY-20190905085644

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015695
Report Date: 09/04/2019
Date Signed: 09/05/2019 08:56:56 AM

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:	CHERRY BLOSSOM CHILDCARE & PRESCHOOL		FACILITY NUMBER:	198015695
ADMINISTRATOR:	LYNN MARROQUIN		FACILITY TYPE:	840
ADDRESS:	906 S. GRAND AVENUE		TELEPHONE:	(626) 335-5500
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY:	45	CENSUS: 0	DATE:	09/04/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Martha Alvarez		TIME COMPLETED:	02:30 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	SCHOOL AGE: A unannounced Random site inspection was conducted on this date, by Cynthia Reyes and Alicia Bailey, LPA's. All areas identified on the Facility Sketch were inspected and checked the following: Fingerprint clearances, staff/child ratio, children and staff records, food preparation area, storage and refrigeration, rest rooms, equipment, outside play area and over all conditions of facility. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet, and mats/cots was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperatures, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records was made. (Please contact your analyst for regulations if considering using Nebulizer or administering Blood-Glucose testing.) Incidental Medical Services was discussed. A notice of site visit was posted today and licensee was explained that it must remain posted for a period or 30 days. Failure to keep poster posted will result in a $100.00 civil penalty. School is open M-F 630 AM-630 PM.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHERRY BLOSSOM CHILDCARE & PRESCHOOL	FACILITY NUMBER: 198015695
	VISIT DATE: 09/04/2019

NARRATIVE

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Breakfast, AM snack, Lunch. PM snack menus, food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. A review of cleaning and food supply storage areas was made. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met appropriately. Staff was questioned to establish their familiarity of emergency reporting requirements, emergency disaster plans and other site operations. Sign in and out sheets and procedures were reviewed with staff, policy of checking children for illnesses. Personal Rights of children were discussed and observed by LPA. Children were interviewed for general observations of facility operation. Transportation policy and procedures were reviewed for safety requirements. Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, Director Qualifications and verification of CPR/First Aid and health preventive practices documentation. Inspection of required forms was made. Children and Staff confidential name report (lic 811) was given and documented on this date. No weapons or bodies of water on premises. The smoke detectors, carbon monoxide & fire extinguisher are in operable condition.

Consultation was conducted on this date. No Citation on this date.

Recent regulatory changes were discussed (including SB 933). Exit interview was conducted including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

****Licensee advised that signing the report does not imply agreement with the findings but is acknowledging receipt of the licensing report.****

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHERRY BLOSSOM CHILDCARE & PRESCHOOL	FACILITY NUMBER: 198015695
	VISIT DATE: 09/04/2019

NARRATIVE

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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

Health & Safety Code 1597.622(a1)

Employees or volunteers at family day care home; immunization requirements; records; exemptions Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC809 (FAS) - (06/04)

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