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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600915
Report Date: 09/23/2021
Date Signed: 09/23/2021 12:09:02 PM

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: 18DATE:
09/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Karen Wishart Director
Mary Wieczorek, Assistant Director
TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Tina Nguyen conducted an onsite inspection for the purpose of a Required - 1 Year. LPA Nguyen meet with director Karen Wishart and Assistant Director Mary Wieczorek. Director Karen needs to leave for appointment. LPA Nguyen and assistant director toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 4 preschool staff and 18 preschool children. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 6:30 am to 6 p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Lunch are provided by parents. Snacks are provided by facility. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by cups and pitcher. The children's bathrooms are clean and sanitary. Children nap on cots/mats, and bedding is stored individually and is taken home weekly to be washed by parents. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility

Staff files were reviewed for staff present during the facility inspection on this date, 3 staff files were reviewed. Health screening and immunizations as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. (continue on page 2)
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
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 5
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
VISIT DATE: 09/23/2021
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Proof of immunization against pertussis, measles for (licensee and assistant) were reviewed and within compliance.
Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. Personnel records were reviewed and the Mandated reporter training of Staff #1 (S1), Staff #2 (S2); Staff #3(S3) were expired on 2018. LPA Nguyen provded the link for the Mandated Reporter training for Child Care provider: https://mandatedreporterca.com/training/child-care-providers#:~:text=The%20new%20Mandated%20Reporter%20Training%20for%20Child%20Care,section%20will%20include%20practice%20test%20questions%20or%20vignettes.

At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 04/10/2023. The facility representative was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. Facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance. Children's records were reviewed, and there was a separate, complete and current record for each child. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.

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 outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height.The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material sand around the climbing equipment, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by water pitcher and disposable cups.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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
VISIT DATE: 09/23/2021
NARRATIVE
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The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Transfer Request (LIC9182). The facility representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov facility representative may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The (licensee / director/ facility representative) was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative. Facility Director does/does not have lead training Certificate.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the (licensee / director/ facility representative).
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
(IF SPANISH) Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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
VISIT DATE: 09/23/2021
NARRATIVE
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Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold
A copy of the Provider Information Notice (PIN) 20-06-CCP Social and Physical Distancing Guidance and Healthy practices for childcare facilities in response to the global coronavirus (COVID-19) pandemic written in collaboration with the CA Department of Education. A copy of COVID-19 posters and Essential workers list.

Based on LPA observations and record reviews the following violation was observed and being cited in accordance with Health and Safety code 1596.8662(4)(b)(1). Please refer to attached 809D for documentation of deficiency.
An exit interview conducted with Assistant director in English. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the Regional Manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
- Fire Drill Log
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 09/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2021
Section Cited

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HSC1596.8662(4)(b)(1)On or before March 30, 2018, a person who, ..licensed child care provider, administrator, ... mandated reporter training provided pursuant to paragraphs (2) and (3) of ... mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.This requirement is not meet:
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Base on record review and observation, S1,S2, S3's Mandated reporter training certificate expired. S1's certificated expired 03/27/2018; S2's certificated expired 03/28/2018; S3's certificated expired 08/30/2018. This poses a potential Health and Safety 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: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2021
LIC809 (FAS) - (06/04)
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