304370735-8-15-2019-06-CC-JMHN-BF422P-20190815170104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370735
Report Date: 08/13/2019
Date Signed: 08/15/2019 05:01:18 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:	FUN 4 KIDS PRESCHOOL		FACILITY NUMBER:	304370735
ADMINISTRATOR:	MANSPERGER, ASHLEY		FACILITY TYPE:	830
ADDRESS:	23721 LA PALMA AVENUE		TELEPHONE:	(714) 694-0901
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92887
CAPACITY:	36	CENSUS: 2	DATE:	08/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Emily Yoon - Administrator		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	Licensing Program Analyst (LPA), Han conducted an unannounced annual/random inspection of the facility on today's date. LPA Han toured the facility with the administrator, Emily Yoon inside and outside. Census was taken in individual classrooms. The overall census observed was 2 infant staff and 2 infant children. Children were playing indoor area. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Operating hours are 6:00 am- 6:30 pm, Mon-Fri. The items which could pose a danger to children such as detergents, cleaning compounds, and medications were stored out of the reach of children. LPA observed expired medications with staff#4. Staff#4 removed all expired medications immediately. Poisons/Hazardous Items are not kept on the premises. Food is properly stored. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary. Staff#3 stated children nap in cribs and bedding is taken home weekly to be washed by parents. LPA observed a sink next to the diaper changing table is not in working condition. The sink space is full of baby books and toys. Staff#3 stated staff are not using this sink and use other sink which is more than 10 feet away from the diaper changing table. Staff#4 stated staff cleaned diaper changing table and sink area to use during the inspection. The facility has conducted an emergency drill within the past six months. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. The playground was completely fenced. The playground equipment appeared in safe condition. There is sufficient cushioning underneath climbing structures and play equipment to absorb falls. Sign in/out procedure was reviewed. LPA observed several missing signatures and sign in and out times.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: FUN 4 KIDS PRESCHOOL	FACILITY NUMBER: 304370735
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Staff Records

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
	Deficient Practice Statement
1 2 3 4	Based on record review, director failed to ensure to maintain Staff#1's mandated reporter training certificate in the file. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/27/2019
	Plan of Correction
1 2 3 4	Director will submit staff#1's mandated reporter certificate by email by due date.

Type B

Section Cited

CCR

101439(h)(4)

Physical Plant

(h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.
	Deficient Practice Statement
1 2 3 4	Based on observation, director failed to ensure staff use sink that is within arm's reach from the diaper changing table. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/13/2019
	Plan of Correction
1 2 3 4	Site supervisor cleaned diaper changing table's sink area during the inspection. Staff is now using sink that is within arm's reach from the diaper changing table.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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: FUN 4 KIDS PRESCHOOL	FACILITY NUMBER: 304370735
	VISIT DATE: 08/13/2019

NARRATIVE

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At 9:40AM, LPA Han met staff#4, Site Supervisor. Staff#4 stated current director had car accident at the end of April. Staff#4 stated she called licensing office on 5/21/2019 and report change of director. LPA Han did not receive any phone call, email, nor a new director’s packet regarding temporary director. Per staff#4, director will resume to work as director on 8/19/2019. LPA observed required Personal Right form (LIC 613A) is not posted in a prominent, publicly accessible area in the center. Staff#4 posted during the inspection.

During today's visit staffing ratios were being met. At least one staff member present possesses current CPR/First Aid certifications, which expires 8/2019. Children's and staff files were reviewed for compliance. Children's and staff files were in substantial compliance.

The facility does not provide Incident Medical Services.
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

Based on LPAs observations, record reviews, and interviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101439(h)(4), 101439.1(e) (1), 101226(e) (6), 101212(b), 101229.1(a)(1), 101223(b)(2) and Health and Safety 1596.8662(b)(1). Please refer to attached 809D for documentation of deficiencies.

Proof of immunizations against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792.
Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: FUN 4 KIDS PRESCHOOL	FACILITY NUMBER: 304370735
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(a)(1)

Children Records

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
	Deficient Practice Statement
1 2 3 4	Based on record review, director failed to ensure to maintain full legal signature and record time for in/out for children. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/27/2019
	Plan of Correction
1 2 3 4	Site supervisor will send out reminder letter to families. Administrator will review sign in and out sheet daily and follow up with parents on the next day. Site supervisor will send reminder letter to LPA by email.

Type B

Section Cited

CCR

101223(b)(2)

Personal Rights

(2) The center shall post a copy of the LIC 613A (9/96) in a prominent, publicly accessible area in the center.
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, director failed to ensure to post Personal Right (LIC 613A) in a prominent, publicly accessible area in the center. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/13/2019
	Plan of Correction
1 2 3 4	Site supervisor posted Personal Right form during the inspection.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: FUN 4 KIDS PRESCHOOL	FACILITY NUMBER: 304370735
	VISIT DATE: 08/13/2019

NARRATIVE

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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

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

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org
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. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

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)
- Daily Activity Schedule
Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal Rights and deficiencies were discussed. The director was provided a copy of their 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 Licensing office within 15 business days. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov The 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 $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: FUN 4 KIDS PRESCHOOL	FACILITY NUMBER: 304370735
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101439.1(e)(1)

Physical Plant - Infant Care Center Napping Equipment

(e) Each infant's bedding shall be used for him/her only. Such bedding shall be replaced when wet or soiled, or when the crib, mat or cot is to be occupied by another infant. (1) Bedding shall be changed daily, or more often if required by (e) above.
	Deficient Practice Statement
1 2 3 4	Based on interview, director failed to ensure to change bedding daily for infants. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/27/2019
	Plan of Correction
1 2 3 4	Site supervisor will requset parents to bring 5 sheets per week and change daily. Site supervisor will submit letter of correction by due date by email.

Type B

Section Cited

CCR

101226(e)(6)

Children Records - Health-Related Services

(e) In centers where the licensee chooses to handle medications: (6) When no longer needed by the child, or when the child withdraws from the center, all medications shall be returned to the child's authorized representative or disposed of after an attempt to reach the authorized representative.
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, director failed to ensure to remove expired medications from the facility. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/27/2019
	Plan of Correction
1 2 3 4	Site supervisor removed all expired prescription/non-prescription medications from medication box during the inspection. Staff#4 stated she conduct the training with closing staff. Site supervisor will submit training plan statement and closing staff names by email.

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: FUN 4 KIDS PRESCHOOL	FACILITY NUMBER: 304370735
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(b)

Reporting Requirements - Reporting Requirements

(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
	Deficient Practice Statement
1 2 3 4	Based on interview, site supervisor failed to ensure to report to the licensing office within 10 days of a change of center director. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/19/2019
	Plan of Correction
1 2 3 4	Site supervisor stated current director is coming back to work as full time as of 8/19/2019. Director will contact LPA Han by phone on 8/19/2019. 714-309-7211

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

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