304312727-9-17-2019-06-CC-GMAI-BG4P3C-20190917105718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312727
Report Date: 09/17/2019
Date Signed: 09/17/2019 10:57:42 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:	GREENSPAN, CYNTHIA		FACILITY NUMBER:	304312727
ADMINISTRATOR:	GREENSPAN, CYNTHIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 990-7050
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92807
CAPACITY:	14	CENSUS: 2	DATE:	09/17/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Cynthia Greenspan - Licensee		TIME COMPLETED:	11:30 AM

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 random/annual inspection was conducted today by Licensing Program Analyst (LPA) Mai. Met with licensee, Cynthia Greenspan, and 2 assistants, and licensee guided analyst on a tour of the Early Childhood Setting. Present at the time of the inspection were 2 day care children, both are preschoolers. There are presently 2 adults living in the home. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The home were toured inside and outside, licensee was operating within the licensed capacity. Operating hours are 8:30AM to 4:30PM, Monday through Friday. Licensee stated that OFF LIMITS areas are: entire upstairs, kitchen and garage. Licensee acknowledged that children may never enter these off-limit areas. Cleaning solutions/chemicals, sharp utensils, and sharp knives are all inaccessible. License stated poisons/hazardous items are not kept on the premises. License understands that cleaning solutions/chemicals must be made inaccessible to children at all times and poisonous items must be key/combo locked at all times. Fire extinguisher (3A:40BC) observed to be fully charged, smoke detectors and carbon monoxide detector were present and tested during inspection. Fire drill log, children's files and rosters were reviewed on today's inspection. LPA verified there is a working telephone service (landline). The applicant stated that there are no firearms on the premises and none were observed during today's visit. LPA Mai advised anytime when firearms are present, they must be locked and stored separately from the ammunition. There are age appropriate toys and napping equipment on the premises for the potential ages served. The licensee stated she is present in the home and ensures that the children in care are supervised at all times. The licensee stated children are not left in parked vehicles. The licensee states when temporarily absent from the home, she arranges for a substitute adult to care for and supervise children in her absence. Page 1 of 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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: GREENSPAN, CYNTHIA	FACILITY NUMBER: 304312727
	VISIT DATE: 09/17/2019

NARRATIVE

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The following electronic links were also provided:
SIDS: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.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
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
The Chaptered Legislation for AB 2084 (Nutritious Beverages) http://ccld.ca.gov/res/pdf/12APX-11.pdf

In the areas that were evaluated, the following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Health and Safety Code HSC 1597.622.

Inspection, report review and exit interview was conducted. Notice of Site Visit was posted during the visit. Facility representative 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. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

[End of Report]

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

Page: 4 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GREENSPAN, CYNTHIA	FACILITY NUMBER: 304312727
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/17/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/30/2019 Section Cited	1 2 3 4 5 6 7	Effective September 1, 2016, a person may not be employed or volunteer at a child care center or a family child care home unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption...This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review and interviews, Licensee failed to obtain proof of immunizations/immunity against measles and pertussis for Staff #2. This poses a potential health risk to children in care.	8 9 10 11 12 13 14
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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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GREENSPAN, CYNTHIA	FACILITY NUMBER: 304312727
	VISIT DATE: 09/17/2019

NARRATIVE

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No smoking, No infant walkers, No Johnny jumpers, No exersaucer or any other similar items that fall into that category are allowed in the facility.

LPA observed pediatric CPR/First Aid certification (expires 09/08/2020) they are EMSA approved and current for the licensee and assistant. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and assistants were reviewed and not within compliance of SB 792, Staff #2 did not have proof of immunization on file.

Incidental Medical Services (IMS) policy was discussed, licensee stated she does not plan to provide it at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the licensing office within 30 days of providing IMS. The plan should describe the facility’s policies and procedures that ensure the proper safeguards are in place. 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

LPA reviewed Unusual Incident Report form and advised the applicant to contact Licensing Officer of the Day within 24 hours by phone or fax and complete the Unusual Incident Report (LIC 624B) within seven days. LPA reviewed with the licensee of Title 22 regulations, requirements of disaster drills, LIC 311D posting requirements, children’s records, facility/staff records, immunizations, mandated child abuse and injury/death reporting.

A Child Care Provider’s Guide to Safe Sleep packet, Safety Seat, Never Ever Shake a Baby information, California Child Passenger Safety Law were discussed and recommended to be posted. Safe Sleep Regulation and Effects of Lead Exposure were discussed and provided to the licensee. The licensee was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi Mai	TELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4