198020291-11-15-2021-33-CC-CRES-C8SVS5-20211115154058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020291
Report Date: 11/15/2021
Date Signed: 11/15/2021 03:41:07 PM

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:	MADISON CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	198020291
ADMINISTRATOR:	KYM ALLEN		FACILITY TYPE:	830
ADDRESS:	1351 S. MAIN ST		TELEPHONE:	(909) 622-9805
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	16	CENSUS: 7	DATE:	11/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mukta Cham		TIME COMPLETED:	03:39 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	Licensing Program Analyst (LPA) Cynthia Reyes, conducted an unannounced annual inspection, as well as a decrease of the infant capacity from 16 to 8 and add a toddler option capacity of 8, on 11/15/2021 at 8:45AM. LPA met with Child development program assistant, Mukta Cham, and provided a copy of the Entrance Checklist for Child Care Centers form (LIC 125). Mr. Cham guided LPA on a tour of the facility. This is an Infant program which consists of two (02) classrooms. Infants will use room 5 and the proposed toddler option will use room 7. Facility operating hours are from 7:30AM to 3:30PM, Monday through Friday. All areas identified on the Facility Sketch were inspected. The following was observed during the tour of the facility: Room 5: Staff #1, #2, and #3 with 7 infants; Room 6 is the office, and Room 7 is empty as it is being inspected for use of the toddler option. The facility was observed to be within the license capacity and limitations. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. LPA observed napping equipment of 5 cribs (2 are evacuation cribs) and 5 cots. The office has an extra crib if needed. Napping equipment and bedding was inspected to be in good condition, appropriate storage and cleanliness. Linens are washed weekly. The isolation area is located in the office between the two class rooms (5 & 7) which also has a staff rest room located in the kitchen behind the office. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Mr. Cham states there are no poisons located at the facility. Carbon monoxide and smoke detectors were observed and are operable. Mr. Cham stated there are no weapons or firearms on the premises. REPORT CONTINUES ON NEXT PAGE: 1 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

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: MADISON CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198020291
	VISIT DATE: 11/15/2021

NARRATIVE

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All toilets (2) and hand washing (2) facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the office is used as an isolation area. A crib and cot are available. 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. Staff restroom in the kitchen is used for ill children.

Menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. The facility provides breakfast, lunch and PM snack. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. The kitchen is located behind the office (Room 6) in between class rooms 5 & 7. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. There is drinking water available indoors and outdoors.

All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. The licensee takes measures to keep the facility free of flies, other insects and rodents.

The outdoor playground was inspected and the play 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, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. LPA did not observe any bodies of water on the premises. LPA advised that the requested toddler option will need their own outdoor pay yard by separation or a gate to be installed or a waiver request to share the infant yard.

Mr. Cham 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.

There is at least one person trained in CPR and Pediatric First Aid present during this inspection.
Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

REPORT CONTINUES ON NEXT PAGE: 2 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

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: MADISON CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198020291
	VISIT DATE: 11/15/2021

NARRATIVE

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LPA also reviewed staff records. The review of Staff records was documented on the LIC 859. Staff present had proof against TB, measles, pertussis, and influenza.

Medication: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

Infant Care: LPA advised staff, Cribs or play yard shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards shall be free of loose articles and objects. No objects shall be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

SAFE SLEEP: LPA discussed the safe sleep regulations and discussed the Child Care Licensing Safe Sleep at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

REPORT CONTINUES ON NEXT PAGE: 3 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

LIC809 (FAS) - (06/04)

Page: 3 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: MADISON CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198020291
	VISIT DATE: 11/15/2021

NARRATIVE

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Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 09/14/2021. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. LPA observed all changing tables are in arms reach of a sink and meets title 22 regulations.

First Aid supplies were observed in the classroom in a cabinet. According to Staff, medication is only administered to a child when accompanied with a doctor's note and is stored in the classroom.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: Effects of Lead Exposure form during the inspection and discussed the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

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.

There were no deficiencies cited during today’s inspection.

To approve the toddler option a Waiver to share the outdoor play yard or a fence to enclose the toddler yard is needed before a license can be granted.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Child development program assistant, Mukta Cham

END OF REPORT: PAGE 4 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021

LIC809 (FAS) - (06/04)

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