304371494-8-16-2021-06-CC-STOE-C5XQPK-20210816122053

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371494
Report Date: 08/11/2021
Date Signed: 08/16/2021 12:21:03 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:	BOYS AND GIRLS CLUBS-CLINTON CORNER		FACILITY NUMBER:	304371494
ADMINISTRATOR:	RAMIREZ, YUMI		FACILITY TYPE:	830
ADDRESS:	13581 CLINTON STREET		TELEPHONE:	(714) 719-6190
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	24	CENSUS: 0	DATE:	08/11/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:53 AM
MET WITH:			TIME COMPLETED:	02:10 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) Stacy Torrence conducted an onsite prelicensing inspection at this proposed childcare center. LPA met with Yumi Ramirez, Division Director and toured the center. The facility representative has requested to provide care and supervision for 12 infants; ages 12 months to 24 months and toddler option children 18 months to 36 months; Monday through Friday, 7:00 a.m. to 6:00 p.m.Building O; infant classroom: #20 and Toddler classroom: #18. The facility is located on the Garden Grove School District Preschool site of Clinton Corner Family Campus. 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. The staff lounge area will serve as the isolation area for ill children temporarily until parents arrive. There is a bathroom, located in the staff lounge that will be used as the isolation bathroom for ill children and is conveniently located to the isolation area. Medication will be stored in a cabinet above the sink, located in each classroom. Medication administration forms were reviewed. First Aid supplies is stored in each classroom. EMSA approved Pediatric CPR & First Aid are current for the division director and site supervisor expires on 01/2022 and 04/2023, respectively. Site Supervisor completed a Health Safety and Nutrition course on 2018. Lead Poisoning Preventive Course on 05/2021. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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 Continue on next page (1 of 5)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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: BOYS AND GIRLS CLUBS-CLINTON CORNER	FACILITY NUMBER: 304371494
	VISIT DATE: 08/11/2021

NARRATIVE

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Per Division Director, Yumi Ramirez, the facility can not obtain funding to purchase equipment for the facility until they are licensed.

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 a water dispenser and disposal cups
· Sign in/Sign out procedure was reviewed and meets regulation requirements
· There is a working smoke detector, carbon monoxide detector, and fire extinguisher
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· The changing table is within arm’s reach of a sink
· The changing table is padded with raised sides
· Bedding will be taken home by parents once a week to be washed

The infant indoor is physically separate from the toddler option

· Infants will be napping on cots
· Cots will be stored in each classroom
· Infant Needs Feeding Plan

Center food policy is that they will provide breakfast, lunch, and PM snack. Food will be delivered by a vendor. Evaluator reviewed Title 22 Sections 101227 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
Activity Schedule
Notice of Site Visit (LIC 9213) and Type A deficiencies
Plan of Corrections of Type A deficiencies
Granted Waivers (available for review)

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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: BOYS AND GIRLS CLUBS-CLINTON CORNER	FACILITY NUMBER: 304371494
	VISIT DATE: 08/11/2021

NARRATIVE

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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:
Toddler Classroom #18: 27.04 x 34.00 = 919-16 (encumbered space-staff cabinet) = 903 sqft
Infant Classroom #20: 39.07 x 24.06 = 940-16 (encumbered space-staff cabinet) = 924 sqft
Total: 1,827 sqft divided by 35 = 52 children

Toilets: 2 x 15 = 30 children
Sinks: 3 x 15 = 45 children
2 Potty Chair available for children being potty trained: 2 x 5= 10

LPA discussed with the applicant 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 was advised the children's bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the outdoor activity space;
Age appropriate equipment available for children in care
Playground is fully enclosed by an appropriate fencing
Drinking water is available outside by water dispenser and disposal cups
Outdoor activity space is supplied with age and size appropriate play structure
An adequate amount of cushioning material consisting of grass and pour and play
Adequate shade is provided by commercial umbrellas

Total outdoor activity space was measure and is as follows:
Infant Playground: 38 x 37 = 1,406 sqft.
Toddler Option Playground: 38 x 37= 1,406 sqft.
Total: 2,812 sqft divided by 75 = 37 children

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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: BOYS AND GIRLS CLUBS-CLINTON CORNER	FACILITY NUMBER: 304371494
	VISIT DATE: 08/11/2021

NARRATIVE

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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 was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to download forms, Title 22 regulations, and trainings on-line at www.ccld.ca.gov. The applicant 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 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 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
· 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

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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: BOYS AND GIRLS CLUBS-CLINTON CORNER	FACILITY NUMBER: 304371494
	VISIT DATE: 08/11/2021

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LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

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 24.

The applicant will be notified if any additional information is required. A license will be issued for the capacity of 24 after a final review.

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

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.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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