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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600915
Report Date: 05/01/2019
Date Signed: 05/01/2019 11:02:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ST. OLAF CHILDCARE CENTERFACILITY NUMBER:
300600915
ADMINISTRATOR:KAREN WISHARTFACILITY TYPE:
850
ADDRESS:12432 NINTH STREETTELEPHONE:
(714) 530-8930
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:84CENSUS: 38DATE:
05/01/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director Karen WishartTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ho conducted a case management inspection to follow-up with a self reported incident happened on 4/25/19 regarding Personal Rights.

LPA observed 38 children with 7 staff members including the director. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's inspection, LPA obtained a copy of the Personnel Report, Police officer's information, and Unusual Incident Report. LPA reviewed children's and staff records. LPA took picture of the nap room. LPA informed the director that the Unusual Incident is assigned to IB Investigator who will return to conduct the investigation.

After reviewing children and staff's records, the following deficiency was observed and cited during today's inspection.

The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. OLAF CHILDCARE CENTER
FACILITY NUMBER: 300600915
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2019
Section Cited
HSC
1596.8662(b)(1)
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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training. This requirement was not met as evidence based on file review. During today's inspection at 10:00am, 5 staff files review conducted
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Director stated all of her staff members already took the trainings, except for 1 staff member. She will send proof of training to LPA by 5/22/19.
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and all 5 staff files were missing the mandated training certificates.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
LIC809 (FAS) - (06/04)
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