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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191226432
Report Date: 02/04/2025
Date Signed: 02/04/2025 12:12:59 PM

Document Has Been Signed on 02/04/2025 12:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SUSANNA WESLEY CHILDREN'S CTR/INFANTFACILITY NUMBER:
191226432
ADMINISTRATOR/
DIRECTOR:		RENEE SPIVEYFACILITY TYPE:
830
ADDRESS:134 N. KENWOOD ST.TELEPHONE:
(818) 548-6229
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 9DATE:
02/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Renee Spivey TIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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On 02/04/2025, at 08:45 am ,Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced annual random inspection. Upon arrival , LPA let the front desk know , who notified facility representative regarding the visit . At 09:30 am , LPA met with Facility Representative , Renee Spivey ,who guided the LPA on a tour of the facility. This is an infant program located at the First United Methodist Church of Glendale property. The infant program consists of one classroom Busy Bee`s with 2 areas. One area for infants 0-12 months , other area 12-24 months .The infant program operates Monday – Friday from 7:30 AM – 5:30 PM. There is a preschool program on site, License # 191204631. The infant program is physically separate from the other components at this facility both indoors and outdoors. Per Facility Representative there are 16 infants enrolled.

LPA observed all required forms/publications posted in the hallway .

Upon arrival LPA observed 9 infants with 3 staff members. Teacher child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision, including visual supervision. Licensed facility is within the conditions, limitations, and capacity specified on the license.
The classrooms furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Furniture and equipment are age appropriate for height and size of infants. All classrooms were inspected to ensure that the floors have a surface that is safe and clean. All materials and surfaces accessible to children are toxic free. Each infant has labeled storage for its belongings. Infants have sufficient changes of clothing and diapers to be always clean and dry. Diaper changing area is clean and within arm's length of a sink with running water and dispensable soap. LPA observed diaper changing table in the corner of the room. LPA discussed with the Facility Representative need of padded surface during the diaper change no less than one inch thick covered with washable vinyl or plastic.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
VISIT DATE: 02/04/2025
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 Diaper changing area had a side raised at least 3 inches to present the infant from rolling off the mat. Soiled diapers are sealed in plastic bags and dispose of in a trash can that is inaccessible to curious infants.
Napping equipment and bedding were inspected for good condition, appropriate storage, and cleanliness.

At 09:50 am , LPA observed 8 cribs used for napping were placed in the activity area . Per Facility Representative they have total of 9 cribs. LPA observed one crib in the napping area . Per Facility Representative cribs were moved to have more space between cribs . LPA explained Facility Representative cribs need to be placed separate from the activity area and regulation was provided .

Infants able to pull themselves up ,sleep on mats.
Cribs used by younger infants . Mattress is at its lowest position and side rail cannot be lowered. Mattress is covered with vinyl or similar moisture resistant material. Bedding is replaced when wet or soiled or when being occupied by another infant. Facility washes linens as needed .

LPA observed that there are functioning smoke and carbon detectors in the facility. LPA observed a fully charged and serviced fire extinguisher with the service date 08/16/2024. Emergency disaster drill was last conducted on 10/2024. Facility Representative states there are no weapons, firearms, or bodies of water on the premises.

Food preparation is done within the room. Separate sink is used for washing hands and dishes as needed. Bottles and food are brought from home. Bottles and food brought from home labeled with the infant’s name. Cabinet space and refrigerator are used for storing food items and perishables. Microwave oven is used for warming up foods while bottles are warmed up in bottle warmers.

First aid bag was observed in the classroom. Trash cans used to discard food have tight fitting lids. Drinking water is readily available both indoors and outdoors, children bring their own water bottles too. The facility was observed to be free of flies, other insects, and rodents.

Infant Outdoor play area is located at the other side of the Church building in the corner of Broadway and Kenwood. Per director, infants are transported via strollers via sidewalk to the outdoor play area. Outdoor playground equipment is in safe condition, free of sharp, loose, or pointed parts.


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
VISIT DATE: 02/04/2025
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 The surface of the outdoor activity space is maintained in a safe condition and is free of hazards . Turf is used as cushioning material throughout majority of the yard. LPA observed empty sandbox . Per Facility Representative she will convert sandbox into the padded play area for the infants . There is adequate shade in the play yard. During the inspection , LPA observed building maintenance cleaning the yard .

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed sheets placed on the table in the front of the classroom .

Children’s Records were reviewed to ensure that Identification and Emergency form and required infants needs and service plan are on file .Inspection of required forms was made and documented on the LIC 857.

At 11:10 am ,LPA reviewed 5 staff records. During the review LPA observed 3 out of 5 records were missing proof of immunization.

Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. The review of Staff records was documented on the LIC 859.

At 11 :25 am , LPA observed 2 out of 5 records were missing Mandated Reporter Certificates .


AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a childcare facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
VISIT DATE: 02/04/2025
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LPA advised the licensee to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.
LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


Facility Representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.



For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP)
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LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP and no lead exceedance was detected .

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
VISIT DATE: 02/04/2025
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on the LPA observations and records reviews, the following deficiencies listed on the attached LIC 809D(Deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.


The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

An exit Interview was conducted, a copy of this report along with Notice of Site visit , Deficiency pages and Appeal Rights were explained and provided to the Facility Representative , Renee Spivey on 02/04/2025.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/04/2025 12:12 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 02/04/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101438.3(c)(1)
Indoor Activity Space For Infants
(1) The sleeping area for infants shall be physically separate from the indoor activity space. This separation shall be accomplished as specified in (b) above.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations , interview and records review the licensee did not comply with the section cited above. During the tour , LPA observed 8 cribs in the indoor activity area , which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2025
Plan of Correction
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Licensee stated cribs will be moved back into the napping room and LPA will be notified by POC date .
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations , records review and interview , the licensee did not comply with the section cited above. During the file revew LPA observed 3 out of 5 were missing immunizations records, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2025
Plan of Correction
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/04/2025 12:12 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 02/04/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and records review , interview , the licensee did not comply with the section cited above. Duirng the file review 2 out of 5 were missing Mandated Reporter Training certificates , which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/18/2025
Plan of Correction
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Licesee stated she will obtain certificates from the staff and will notify LPA by POC date .
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025


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