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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019065
Report Date: 05/04/2022
Date Signed: 05/04/2022 06:23:22 PM


Document Has Been Signed on 05/04/2022 06:23 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:BLOOMING FLOWERS CHILD CARE CENTERFACILITY NUMBER:
198019065
ADMINISTRATOR:THOMAS, JAZMYNEFACILITY TYPE:
850
ADDRESS:680 E. ARROW HIGHWAYTELEPHONE:
(562) 805-0005
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:60CENSUS: 25DATE:
05/04/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Licensee Elaine DavisTIME COMPLETED:
06:30 PM
NARRATIVE
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An unannounced, in-person Case Management-Deficiencies inspection was conducted on this date by Licensing Program Analyst (LPA) Emiko Bell in order to cite for deficiencies observed during an inspection. Licensee Elaine Davis arrived at 02:45 pm.

Upon LPA's arrival, LPA was greeted by staff Destiny Carcoba, who permitted LPA to enter the Center.

LPA and staff wore face coverings the duration of the inspection as a precautionary measure against COVID-19. The COVID screening questions were posed and all were responded to with "No."

When LPA arrived, the children were napping, so LPA walked through to take census. There were four staff with 25 children in the pre-school room and one staff was in the kitchen.

When given the names of the staff, LPA noted that one staff, Karishma Patel (aka "Miss Krissy:), was not associated to the license. When Licensee Davis arrived, LPA phoned Seasonal Clerk Esther Davila-Aguilar in Licensee Davis's presence and had her verbally confirm who was associated to both Davis Family Child Care Home and to Blooming Flowers Child Care Center as verification that Karishma Patel is not associated to Blooming Flowers CCC. As Karishma Patel began working at Blooming Flowers CCC on 03/18/21, a Type B citation has been issued and a $500 civil penalty has been assessed.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065
VISIT DATE: 05/04/2022
NARRATIVE
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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.

Exit interview conducted and report was reviewed with Licensee Elaine Davis.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/04/2022 06:23 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: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/05/2022
Section Cited

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CRIMINAL RECORD CLEARANCE

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility Request a transfer of a criminal record clearance as specified in Section 101170(f).
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-This requirement is not met as evidenced by: Karishma Patel has Criminal Background Clearance but is not associated to Blooming Flowers CCC. A civil penalty of $500 has been assessed.
*This poses a potential health, safety and/or personal rights risk to the children in care.*
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
LIC809 (FAS) - (06/04)
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