198015952-7-26-2019-54-CC-AJLO-BEFP38-20190726105706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015952
Report Date: 07/26/2019
Date Signed: 07/26/2019 10:57:13 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	BETHANY MANOR DEVELOPMENT AND LEARNING CENTER		FACILITY NUMBER:	198015952
ADMINISTRATOR:	RENEE KOSKA		FACILITY TYPE:	850
ADDRESS:	15415 S. PIONEER BLVD.		TELEPHONE:	(562) 868-1517
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	64	CENSUS: 11	DATE:	07/26/2019
TYPE OF VISIT:	Annual/Random	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Leena Willis, Teacher		TIME COMPLETED:	11:15 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	An unannounced Annual Random Inspection was conducted on this day by Licensing Program Analysts (LPAs) A. Lucero and F. Vasquez. Facility is currently licensed for a capacity of 64 children. Licensing staff met with Leena Willis as Director Renee Koska was unavailable. The program currently operates Monday, Wednesday and Friday from 9:00am to 12:00 noon. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of the site visit, there is a total census of 11 children and a total census of four teachers present. Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings was observed. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Toys observed to be clean. A first aid kit is kept in each classroom. Carbon monoxide detectors and smoke detectors are present in the facility. Fire extinguishers have been serviced in December 2018. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. The facility does not provide a snack for children as the children are only present for three hours a day, but do provide a snack time. Parents provide snacks for children, but the facility does have extra snack in the even a child's representative forgets to bring a snack. No lunch is served. The outdoor area was inspected. The children primarily use the Gross Motor Room for play activities; however, an outdoor grassy area is utilized in the event outdoor play area is needed for 15 minutes. LPA Lucero advised Teacher that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. Outdoor play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BETHANY MANOR DEVELOPMENT AND LEARNING CENTER	FACILITY NUMBER: 198015952
	VISIT DATE: 07/26/2019

NARRATIVE

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LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

These forms may also be downloaded from our website: www.ccld.ca.gov

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BETHANY MANOR DEVELOPMENT AND LEARNING CENTER	FACILITY NUMBER: 198015952
	VISIT DATE: 07/26/2019

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Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires in 09/2019 for staff #2. Inspection of required forms made.

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

The following was discussed with the Director:

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2019

LIC809 (FAS) - (06/04)

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