198019504-12-17-2019-30-CC-DADS-BJXS5E-20191217123412

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019504
Report Date: 12/17/2019
Date Signed: 12/17/2019 12:34:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	OUR VILLAGE PRESCHOOL		FACILITY NUMBER:	198019504
ADMINISTRATOR:	K.HESKE & N.COMBS		FACILITY TYPE:	850
ADDRESS:	720 SO. MAIN STREET		TELEPHONE:	(818) 848-0206
CITY:	BURBANK	STATE: CA	ZIP CODE:	91506
CAPACITY:	70	CENSUS:	DATE:	12/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Nikki Combs, Krista Heske		TIME COMPLETED:	01:00 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

12/17/2019 Licensing Program Analyst Dalicia Adkins and Jeanette Estrada conducted an unannounced visit for the purpose of annual inspection. LPA met with Co- owners/Directors Nikki Combs and Krista Heske who guided LPA on a tour throughout the home. Entire facility including all yards were inspected. Children census 57 and five operating classrooms.

This a Day Care Center with 5 classrooms (all rooms are been utilized for care) children’s play yard kitchen and office. Facility capacity is 70 children, operation hours are 7am-6pm.

LPA Dalicia Adkins and Jeanette Estrada conducted observation and evaluation of: (1) care and supervision of children (2) Children’s records (3) Staff Records and Qualifications (4) Physical Plant.

LPA observed posting requirements LPA observed parent board: Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist, Notification of Parents Rights (LIC PUB 394), Parents Rights (LIC 9148), Facility License (LIC 203) , Personal Rights (LIC 613A), Weekly Menu, Child Passenger Restraint System (PUB 269) and Daily Activity Schedule.

LPA Observed General Requirements: fully charged fire extinguisher (2A:10BC), Carbon Monoxide Detector, Smoke Detectors, Working Landline, CPR Cards, Sign in and out Sheet. Facility observed to be well ventilated and adequate lighting.

First Aid Kit: located in all five classrooms

Per Director no fire arms on premises
Kitchen: knives and sharps are inaccessible. Store medication in a locked/ inaccessible with operable fire extinguisher. (kitchen is off limits and inaccessible) PAGE 1

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OUR VILLAGE PRESCHOOL	FACILITY NUMBER: 198019504
	VISIT DATE: 12/17/2019

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
26
27
28
29
30
31
32

CLASSROOM #1 ( Lady Birds) , 2 teachers and 10 children (2 years old).LPA observed safe and age appropriate toys. Available cots for napping, individual storage for children’s belonging. LPA observed one changing table and one stepping stool for children. Furniture is in good repair. Drinking water ready available and trash can with lid.

CLASSROOM#2 (Fire Flies ) 2 teachers and 12 children (2-3 years old). LPA observed safe and age appropriate toys. Available cots for napping, individual storage for children’s belonging. LPA observed one changing table and one-stepping stool for children. Furniture is in good repair. Drinking water ready available and trash can with lid.

CLASSROOM#3 (Butterflies ) LPA’s observed 2 teacher and 15 children ( 3 years old) . LPA observed safe and age appropriate toys. Available cots for napping, individual storage for children’s belonging. LPA observed one changing table and one-stepping stool for children. Furniture is in good repair. Drinking water ready available

CLASSROOM#4 (Dragon flies ) LPA’s observed 2 teacher and 9 children (3-4 years old) . LPA observed safe and age appropriate toys. Available cots for napping, individual storage for children’s belonging. Furniture age appropriate and is in good repair. Drinking water ready available, trashcan with lid.

CLASSROOM#5(Humming Birds ) LPA’s observed 2 teacher and 18 children (4-5 years old) LPA observed safe and age appropriate toys. Available cots for napping, individual storage for children’s belonging. Furniture is in good repair. Drinking water ready available. Staff bathroom located about three steps away,

PLAY YARD : Outdoor play area is free from defects or dangerous conditions. (Play equipment is securely anchored according to manufacturer directions. Backyard fence is at least four feet high and adequate shade was observed. LPA observed available drinking water. The play yard is divided by gate, both sides are utilized by children. LPA observed 2 swings sets, large slide play structure, small apparatus, and various play toys. LPA observed play structures to be anchored and free of hazards. Play structures has sand underneath providing adequate resilient cushioning.

PAGE 2

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: OUR VILLAGE PRESCHOOL	FACILITY NUMBER: 198019504
	VISIT DATE: 12/17/2019

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
26
27
28
29
30
31
32

Incidental Medical Services Plan of Operation: This facility provides incidental medical services. Staff are trained to administer inhaled medications and EpiPen’s. Assigned staff will administer medication, provided that parents signed consent form, medication labeled with instructions, and parents trained staff on how to administer medication. LPA observed Medication to be stored, labeled and current.

Exit interview conducted and the following topics discussed:

SIDS: New proposed Safe Sleep Regulations and Best Practices, link http://safetosleep.nih.gov
MANDATED REPORTING: must stay current and renew every two years, www.mandatedreportereporterca.com
IMS/ Americans with Disability Act (ADA): Disability rights laws prohibit child care providers from excluding children solely because they have a disability-related need for medication. As a child care provider you must have an individualized plan included in plan of operation submitted to the department.
Child Care Advocate Program: promotes the delivery of quality child care, link childcareadvocatesprogram@dss.ca.gov
CHILD CARE QUARTERLY NEWSLETTER: advised to sign up and provided, www.ccld.ca.gov
UNUSUAL INCIDENT/INJURY REPORTING: A report shall be made to the department by telephone or fax during the department’s normal business hours before the close of the next working day (1) following the occurrence during the operation of Family Day Care Home of the event. Health and Safety Code Section 1597.467(b)(2). In addition to verbal or fax report ,a written report shall be submitted to the department within seven (7) days. LIC 924 www.ccld.ca.gov

The facility was found to be in compliance per Title 22 regulations. No Type A or Type B deficiencies will not be cited in today’s 12/17/2019 facility evaluation.

This report was reviewed with Director and copy was furnished. A copy of site visit was also furnished. PAGE 3

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3