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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012883
Report Date: 04/07/2022
Date Signed: 04/07/2022 01:58:20 PM

Document Has Been Signed on 04/07/2022 01:58 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CUMORAH KIDSFACILITY NUMBER:
198012883
ADMINISTRATOR:SUSAN COOPERFACILITY TYPE:
850
ADDRESS:4561 DURFEE AVENUETELEPHONE:
(562) 692-1165
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 62TOTAL ENROLLED CHILDREN: 56CENSUS: 39DATE:
04/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee, Rose Nichols and Director Susan Cooper TIME COMPLETED:
02:15 PM
NARRATIVE
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On 04/7/2022 at 8:45 am, Licensing Program Analysts (LPA’s) Roxana Lopez and Steven Tung conducted an unannounced required inspection. A risk assessment was conducted prior to entering the facility. LPA met with Owner Rose Nichols, who guided LPA’s on a tour of the facility. Director, Susan Cooper arrived at 9:05 am and joined the inspection. This is a preschool age program licensed for 62 children which operates Monday – Friday from 6:00 AM – 5:30 PM. Per the Director there are 56 children enrolled.

All areas identified on the Facility Sketch were inspected. The following staff was present during this inspection: Room 1: was emptied, Staff #1 and Staff # 2 were observed outside with 17 children, Room 2: Staff #3 and Staff # 4 with 10 children; Room 3: Staff # 5 with 12 children. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. At 9:15 am LPA’s observed 2 children walk into room # 3 unsupervised. Per children they were coming in to get their water. Director Susan Cooper took children outside and informed teachers that the children were inside unsupervised. Per Staff # 1 children had asked for water, water is available outside via water fountain. The two children that went inside were trying to get their water bottles. The licensed facility is within the conditions, limitations, and capacity specified on the license.

LPA observed the facility to be clean, sanitary and in good repair. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets and washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the office is used as an isolation area.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
Document Has Been Signed on 04/07/2022 01:58 PM - It Cannot Be Edited


Created By: Roxana Lopez On 04/07/2022 at 12:53 PM
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: CUMORAH KIDS
FACILITY NUMBER: 198012883

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229(a)(1)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations ], the licensee did not comply with the section cited above in that 2 children came into room # 3 unsupervised. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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Director took children back outside with teachers- Pre Licensee, they will have a meeting with children informing them that they can not go into the classroom without a teacher. A meeting with stafff will be held and meeting notes and signing sheet will be provided by POC due date of 4/15/2022.
Type B
Section Cited
CCR
101227(a)(6)
Food Service
(6) Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interviews, the licensee did not comply with the section cited above in that menus were not observed to be posted for parents to view which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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Per Licensee and Director the menu will be posted in each classroom and it will add the menu to the monthly calendar. Proof of POC will be submitted by POC due date of 4/15/2022.
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:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022


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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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUMORAH KIDS
FACILITY NUMBER: 198012883
VISIT DATE: 04/07/2022
NARRATIVE
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 There are chairs in the office. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

The facility provides AM snack and PM snack. Children bring their own lunches. Snack menus were reviewed- per Licensee the menus are only posted in the kitchen. LPA advise licensee that menus must be posted at least one week in advance and visible to an authorized representative. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately. There is drinking water available in all indoor classrooms and a water fountain is available outside. Children also take their water bottles outside. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair.

At 9:00 am Disinfectants, cleaning solutions and other items that are dangerous to children were observed to be accessible to children throughout the classrooms. During inspection Licensee removed cleaning supplies and made them inaccessible for children in care. are stored in an area inaccessible to children. Director,states that there are no poisons stored at the facility.

At 9:25 am LPA’s observed that there is smoke and carbon detectors in the facility and found them operable.
Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play 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. Staff Records were reviewed to ensure that a health screening report is on file. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUMORAH KIDS
FACILITY NUMBER: 198012883
VISIT DATE: 04/07/2022
NARRATIVE
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LPA’s issued the LIC 857 and the LIC 859 which documents the staff and children’s files that were reviewed during this inspection.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Manager and Administrator. The Director and her staff currently have immunization documentation.

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

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

LPA discussed the safe sleep regulations with Licensee and Director 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 licensee [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.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUMORAH KIDS
FACILITY NUMBER: 198012883
VISIT DATE: 04/07/2022
NARRATIVE
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 Licensee and Director were reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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’s observations and records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code od Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Rose Nichols and Director Susan Cooper

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 04/07/2022 01:58 PM - It Cannot Be Edited


Created By: Roxana Lopez On 04/07/2022 at 01:09 PM
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: CUMORAH KIDS
FACILITY NUMBER: 198012883

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238g


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observations, the licensee did not comply with the section cited above in that cleaning couponds were observed in unlocked cabinets making them accessible to the children which posesd a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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During inspection Licensee and director moved the items making them innacessible. Per Director she will have a staff meeting and submit proof of meeting notes- with sign in sheet. Proof will be submitted by POC due date of 4/15/2022
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:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022


LIC809 (FAS) - (06/04)
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