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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016792
Report Date: 04/14/2023
Date Signed: 05/03/2023 04:43:35 PM


Document Has Been Signed on 05/03/2023 04:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:KINDER KOUNTRY ACADEMYFACILITY NUMBER:
198016792
ADMINISTRATOR:LUCY SALAZARFACILITY TYPE:
840
ADDRESS:456 W. SAN JOSE AVE. #BTELEPHONE:
9096210226
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:12CENSUS: 0DATE:
04/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Anna VartevaryanTIME COMPLETED:
03:45 PM
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On 4/14/2023 at 9:30 am Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced Annual/Required inspection. LPA met with Director, Anna Vartevatyan. This is a school-age program licensed for 12 children, which operates Monday – Friday from 6:30 AM – 8:00 AM and 2:55 PM – 6:00 PM. Covid Risk Assessment was conducted prior to enter the facility. Per Director, there are 6 children enrolled. Preschool and school-age licenses are conducted in physically separate areas, but within the same building. The outdoor playground is separated by an iron rod gate for both the preschool and school-age children to play, but not together. There is a total of one (1) classroom that is use by the school-age children. Per the Director the school-age children enter the facility through the main door having to cross through the preschool area to the rear/back of the facility where the school-age classroom is located. School-age children use 2 restrooms, one (1) that is for the boys and the other is for the girls, that are located in the preschool area, but are made inaccessible (door remains closed) to preschool children. The preschool children use the restroom located across from the 3-year classroom.

All areas identified on the facility sketch were inspected. LPA observed 0 children due to children being at school during this time of the day. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. Criminal Record Clearances were reviewed.



LPA observed required forms to be posted on the Parent Board located in the office area. LPA observed the following: Facility License, Breakfast/Snack/Lunch Menus for the current month, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. Per Director, Disaster and Fire Drills have not been conducted as required. LPA provided a sample to begin emergency drills and are to be documented. LIC 125 Entrance Checklist provided.

Smoke Detectors were operable, but based on observation, LPA observed that there are no Carbon Monoxide detectors are the premises, which poses/posed a potential health, safety or personal rights risk to persons in care. Per State Fire Marshall standards, fire extinguishers shall be service annually. Fire extinguishers have not been serviced since June 6, 2018.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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 4


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: KINDER KOUNTRY ACADEMY
FACILITY NUMBER: 198016792
VISIT DATE: 04/14/2023
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LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, the Director’s office is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Snack menus were reviewed to ensure that they are being posted one month in advance and visible to an authorized representative. The facility provides Breakfast, Lunch and Snacks. Per Director and staff, children also bring their own lunch. During this time, facility provides bottled water and cups, for children to drink water while at day care. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Per Director, no poisons are at facility.

Outdoor play equipment was observed to be in good condition, free of sharp, loose, or pointed parts. LPA observed age-appropriate toys and equipment. Outdoor activity space surface is maintained in a safe condition. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this inspection. Director states there are no weapons or firearms on the premises.

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.



Staff Records and Children’s Records were reviewed and documented on LIC 857 and LIC 859. LPA conducted record review and found mandated reporting training expired for staff, which poses/posed a potential health, safety, or personal rights risk to persons in care.

This facility does provide Incidental Medical Services – IMS, but per Director, there are no children on medication at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: KINDER KOUNTRY ACADEMY
FACILITY NUMBER: 198016792
VISIT DATE: 04/14/2023
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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.

Director 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.

LPA asked Director if Lead testing had been completed, but according to Director, she stated that facility has not completed Lead Testing, and LPA provided PIN 21.21.1 with links and updates on the requirements. A Technical-Violation has been issued.

Please see LIC 809D for deficiencies that were cited. Deficiencies must be corrected to protect the health and safety of children in care.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and a copy of the report was provided to Director, Anna Vartevaryan along with Appeal Rights.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/03/2023 04:43 PM - It Cannot Be Edited

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: KINDER KOUNTRY ACADEMY
FACILITY NUMBER: 198016792

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA observered that there were no carbon monoxide and Director confirmed there were none on the premise, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/17/2023
Plan of Correction
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Per Director Carbon minoxides dectors will be installed. LPA will plan a visit.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in as staff had an expired mandated reporter training certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/17/2023
Plan of Correction
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Per Director staff will conduct training and provide a copy of the certificate. Director will scan and email to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4