304371296-1-24-2020-06-CC-YVIA-BL62ZW-20200124165101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371296
Report Date: 01/24/2020
Date Signed: 01/24/2020 04:51:12 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:	LA PALMA PEPPER TREE PRESCHOOL		FACILITY NUMBER:	304371296
ADMINISTRATOR:	LLAURY, IRMA		FACILITY TYPE:	830
ADDRESS:	5112 LA PALMA AVENUE		TELEPHONE:	(714) 827-2850
CITY:	LA PALMA	STATE: CA	ZIP CODE:	90623
CAPACITY:	19	CENSUS: 4	DATE:	01/24/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Irma Llaury, Applicant		TIME COMPLETED:	12:30 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 Analysts (LPAs) Yesenia Villa and Carmen Odom conducted an on site pre-licensing visit at this proposed child care center. LPA met with Irma Llaury, Applicant and toured the center. The applicant has requested to provide care and supervision for 19 infants from ages 6 weeks to 24 months of age, Monday through Friday, 6:30 a.m. to 6:00 p.m. in the infant and toddler room. Upon arrival there were 4 infants present with two staff. The facility was observed to be within ratio. A review of the Facility Personnel Report Summary 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. As stated by Applicant the isolation area for the infants is in the infant room in a high chair or on an isolation crib away from the other children, until parents arrive. Medication will be stored in the kitchen as stated by applicant. Ms. Llaury indicates there are no children at this time being administered medication. First Aid supplies were inspected and are stored in the kitchen above the refrigerator. EMSA approved Pediatric CPR & First Aid are current for the director and expires on 08/17/2021. Applicant has not completed the 8-hour Preventative Health Practices and Nutrition Course and states will complete the training as soon as possible. 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

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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: LA PALMA PEPPER TREE PRESCHOOL	FACILITY NUMBER: 304371296
	VISIT DATE: 01/24/2020

NARRATIVE

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The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside by water cups.
· Sign in/Sign out procedure was reviewed and meets regulation requirements
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· The center has cribs for napping purposes and 3 evacuation cribs were observed.
· The changing table is within arm’s reach of a sink
· The changing table is padded with raised sides
· Bedding will be washed daily by parents.
· There is a designated napping area surrounded by a 4 ft wall with sufficient infant napping equipment
· The infant indoor is physically separate from the preschool/toddler component

Food preparation area is equipped with microwave oven, refrigerator/freezer. Center policy is that lunches and snacks are provided by the parents, as stated by the Applicant. Evaluator reviewed Title 22 Sections 101227 and 101327 with applicant and that the licensee is ultimately responsible to provide adequate, nourishing food.

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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: LA PALMA PEPPER TREE PRESCHOOL	FACILITY NUMBER: 304371296
	VISIT DATE: 01/24/2020

NARRATIVE

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· Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies
· Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269)
· Sudden Infant Death Syndrome Poster (recommended)
· Shaken Baby Syndrome Poste r (recommended)

The indoor activity space was measured and is as follows:
Infant Room Length 30.63 X 21.16=648.1308
Toddler Room Length 27.25 X 14.41= 392.6725
Total Space 1040.803 Divided by (35) SQ. Ft. 29.73

1 Toilet X 15 infants and (1) sink was observed during today’s inspection.
Applicant states she does not provide toilet training services for the infant component at this time since the ages of the children in care do not require the service.

LPA discussed with the applicant/facility representative that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, **staff to child ratio requirements, direct visual supervision requirements,

emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant/facility representative was advised the children's bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the indoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by individual bottles.
· Outdoor activity space is supplied with age and size appropriate equipment.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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: LA PALMA PEPPER TREE PRESCHOOL	FACILITY NUMBER: 304371296
	VISIT DATE: 01/24/2020

NARRATIVE

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·An adequate amount of cushioning material consisting of grass and is place under the infant toys.
· Adequate shade is provided by a large tree on the yard.
Total outdoor activity space was measure and is as follows:
62.25 X41.5=2583.27- Encumbered (183.56) =2,399.71.
2,399.71 Divided by (75) SQ FT.= 31.99

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Applicant/facility representative was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and trainings on-line at www.ccld.ca.gov. The applicant/facility representative was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or at www.ccld.ca.gov

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 applicant/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

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the applicant/facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
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
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

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

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: LA PALMA PEPPER TREE PRESCHOOL	FACILITY NUMBER: 304371296
	VISIT DATE: 01/24/2020

NARRATIVE

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· 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.
The facility was in compliance with Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has sufficient activity space to support the capacity of 19 infants. A license will be issued for the capacity of 19 infants after a final review.

Prior to licensing the following areas / documents must be corrected / submitted to the licensing office by the due date of 01/31/2020:
1. 8-Hour Preventative Health and Training for applicant.
2. Program Description for infants only.
3.) List of inventory
4.) Job Description for Director and all titles.

Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file Exit interview was conducted and a copy of this report was provided to the director on this date.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) 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

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020

LIC809 (FAS) - (06/04)

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