198019433-8-12-2021-54-CC-AJLO-C5TTDU-20210812143856

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019433
Report Date: 08/12/2021
Date Signed: 08/12/2021 02:39:06 PM

Document Has Been Signed on 08/12/2021 02:39 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	HONEYCOMB MONTESSORI		FACILITY NUMBER:	198019433
ADMINISTRATOR:	THAMARA WITHANA		FACILITY TYPE:	850
ADDRESS:	20126 PIONEER BLVD		TELEPHONE:	(562) 402-8111
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY: 19	TOTAL ENROLLED CHILDREN: 0	CENSUS: 12	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Thamara Withana, Director		TIME COMPLETED:	03:10 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	An unannounced Required One Year Inspection was conducted on this day by Licensing Program Analyst (LPA) Lucero. Facility is currently licensed for a capacity of 19 preschool children. Licensing staff met with Director Thamara Withana. The program currently operates Monday thru Friday from 8:30am to 5:30pm. At the initial start of the site visit at 12:10pm, there is a total census of 12 children and a total census of two 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. At 12:17pm, LPA observed cubbies available to each child with their name on it. Mat/cot was inspected, each child has their own cot with bedding. Availability of drinking water was reviewed, children have access to drinking water. 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 on the wall in a cabinet. Carbon monoxide detectors and smoke detectors were observed to be present in the facility at 12:46pm but were not tested as some children were beginning to nap. LPA also observed a pull-down switch fire alarm present with a fire bell. Fire extinguishers have been serviced in November 2018. Hazardous items including poisonous cleaning compounds were stored inaccessible to children. Snack/lunch menus are not available. A discussion was held at 12:40pm with Director and it was stated that the facility does not currently offer a morning or afternoon snack as it is provided by parents. LPA informed Director that the facility must provide a morning and afternoon snack and have a snack menu posted. Lunch is brought from home and is warmed and served at the facility.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Armando J Lucero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: HONEYCOMB MONTESSORI	FACILITY NUMBER: 198019433
	VISIT DATE: 08/12/2021

NARRATIVE

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Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. It was stated that children take their water bottles out during play time. LPA Lucero advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

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/First Aid card for Staff #1 was issued by Pediatric Plus and has the EMSA CPR/First Aid stickers on the back. Card is valid until 12/2021.

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.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Armando J Lucero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: HONEYCOMB MONTESSORI	FACILITY NUMBER: 198019433
	VISIT DATE: 08/12/2021

NARRATIVE

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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.

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.

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

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

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Armando J Lucero
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/12/2021 02:39 PM - It Cannot Be Edited

Created By: Armando J Lucero On 08/12/2021 at 01:58 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: HONEYCOMB MONTESSORI	FACILITY NUMBER: 198019433
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/10/2021 Section Cited CCR 101227(5)(a)	1 2 3 4 5 6 7	Food Service Full-day programs shall offer a midmorning and a midafternoon snack. The requirement is not met as evidenced by: During discussion, it was stated that the faciltiy does not offer a midmorning or midafternoon snack. This is a potential risk.	1 2 3 4 5 6 7	Director stated that the facility will purchase foods for midmorning and midafternoon snack, provide LPA a copy of receipts of purchase along with a snack menu to LPA via email by POC date of 09/10/2021.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Armando J Lucero

LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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