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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017126
Report Date: 01/24/2022
Date Signed: 01/24/2022 11:39:14 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:SUNDANCE CHILDCARE CENTERFACILITY NUMBER:
198017126
ADMINISTRATOR:JI HEE SUHFACILITY TYPE:
850
ADDRESS:700 S. ROSEMEAD BLVD.TELEPHONE:
(626) 304-9713
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:50CENSUS: 10DATE:
01/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Ji Hee Suh - DirectorTIME COMPLETED:
11:51 AM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced random inspection. Upon arrival at 8:46am, LPA met with Director Ji Hee Suh. At 8:50am, Director led LPA on a tour of the facility. This is a preschool program which consists of 5 classrooms. Per Director, there are currently 31 enrolled in the program. Hours of operation for this facility are Monday - Friday 8am-5:30pm.

Licensing staff observed all required forms/publications to be posted in the office. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request.

PHYSICAL PLANT: At 8:55am, LPA entered and inspected 2 yr old Classroom: 3 children with 1 staff member, 3 yr old Classroom: 4 children with 1 staff member, 4 yr old Classroom: 3 children with 1 staff member. Per Director, their two additional classrooms are used as activity rooms but have not been assigned as classrooms yet. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. LPA observed the storage of napping equipment in each classroom. Napping equipment was observed to be cots. Each classroom has a separate restroom for their classroom. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly.

All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects and rodents. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water was readily available indoors. Children enrolled are currently bringing their own water bottles from home. At this time, the Office is used as an isolation area. A cot is available for an ill child to rest on. First Aid supplies are available in each classroom and complete. Facility has a functioning carbon monoxide detector that meets statutory requirements. REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
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 5
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: SUNDANCE CHILDCARE CENTER
FACILITY NUMBER: 198017126
VISIT DATE: 01/24/2022
NARRATIVE
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Director states there are no weapons, firearms, or bodies of water on the premises. At 9:03am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/27/2021, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. At 9:08am, LPA observed the facility kitchen. All food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Snacks were reviewed for availability, quantity and appropriateness to children in care. This facility provides breakfast, lunch, and pm snack.

At 9:10am, LPA reviewed the outdoor play area. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is one outside play space that has small age appropriate play structures. Drinking water is readily available outdoors as children bring out their individual water bottles brought from home.

FACILITY RECORDS: 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 files were reviewed for a health screening report and immunizations that meet regulatory requirements. LPA reviewed staff files and observed 3 of 4 staff members without a health screening report in their file. The importance of maintaining health reports conducted by a physician was discussed with the Director. Criminal Record Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. During staff file review, LPA observed that no staff member had a current, valid Pediatric CPR/First Aid Training certificate. LPA discussed the importance of always having a staff on site who has a current Pediatric CPR/First Aid for the health and safety of children in care. Current Mandated Reporter training certificates were only observed in 2 of 4 staff members files. LPA explained the requirement for Mandated Reporters in child care to Director. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed. A random sample of Children’s Records were reviewed to ensure that they are complete. LPA observed Disaster Drill Log that shows fire drill being completed as of 01/20/22.



REPORT CONTINUES PAGE 2 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: SUNDANCE CHILDCARE CENTER
FACILITY NUMBER: 198017126
VISIT DATE: 01/24/2022
NARRATIVE
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INCIDENTAL MEDICAL SERVICES:
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

During this inspection LPA observed all the Health and Safety protocols for COVID-19 being followed at the facility. Signs were posted at the entrance and throughout the facility. LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

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.

Exit interview was conducted with Director Ji Hee Suh, at 11:20am, and Plan of Corrections were reviewed and developed.



REPORT ENDS PAGE 3 of 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SUNDANCE CHILDCARE CENTER
FACILITY NUMBER: 198017126
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 2 out of 4 staff did not have a current, valid Mandated Reporter training certificate, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/31/2022
Plan of Correction
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Per Director, they will have Staff #2 & 4 to have them complete it right away and submit a copy to LPA by POC date 01/31/2022.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

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 4 out of 4 staff members present during the inspection do not have current, valid Pediatric CPR/First Aid training completed, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/24/2022
Plan of Correction
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Per Director, they will have have their staff complete in person Pediatric CPR/First Aid training and submit proof to LPA by POC date 02/24/2022
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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: SUNDANCE CHILDCARE CENTER
FACILITY NUMBER: 198017126
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

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 3 out of 4 staff did not have a completed LIC503 Health Screening Report in their staff file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/24/2022
Plan of Correction
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Per Director, they will have Staff #2, 3, & 4 make appointments with a physician and have their LIC503 Health Screening Report completed. Director will submit copies to LPA by POC date 02/24/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5