Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013177
Report Date: 09/20/2016
Date Signed 09/21/2016 12:59:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARY ALICE O'CONNOR CCLCFACILITY NUMBER:
198013177
ADMINISTRATOR:THEODOROPOULOS, C.FACILITY TYPE:
830
ADDRESS:401 N. BUENA VISTA STREETTELEPHONE:
(818) 846-1063
CITY:BURBANKSTATE: CAZIP CODE:
91506
CAPACITY:20CENSUS: 19DATE:
09/20/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Amanda EdwardsTIME COMPLETED:
06:00 PM
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An unannounced Annual/Random visit was conducted on this date, by Alanda Ricks, Licensing Program Analyst (LPA). Met with Amanda Edwards, Director, who guided analyst tour of the facility. LPA observed 19 Infant/Toddlers enrolled with 6 teachers supervising. There are 19 children in enrolled in the facility.

All areas identified on the Facility Sketch were inspected and checked the following: Infant classroom and toddler classrooms were inspected. LIS clearances, staff/child ratio, children and staff records, food preparation area, storage and refrigeration, rest rooms, equipment, outside play area and over all conditions of facility. LPA discussed with Amanda Edwards, Director the new SB 792 (Mendoza) regarding Immunization and Tuberculosis requirements. LPA has given licensee 30 days to complete staff personnel records with required documentation by October 20, 2016. Director has agreed to be in compliance.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperatures, toilet paper, towels, area safety and sanitation. LPA observed carbon monoxide in classrooms. First Aid supplies were inventoried. LPA reviewed the facilities new IMS updated plan of operation in terms of administering Incidental Medical Services to children in care. A review of medication policy, including administering, labeling, storage, and records was made. (Please contact your analyst for regulations if considering using Nebulizer or administering Blood-Glucose testing.) A notice of site visit was posted today and licensee was explained that it must remain posted for a period or 30 days. Failure to keep poster posted will result in a $100.00 civil penalty.

Failure to obtain a criminal record background check clearances prior to initial presence at the facility will result in an immediate $100.00 dollar or more per day Civil Penalty.

Snack, lunch menus, food and snacks were reviewed for availability, quantity and appropriateness to children in care. Facility utilizes an outside vendor who provides lunches for the children. Service needs plan were observed and reviewed. LPA observed appropriate cribs/mats for napping equipment for infant/toddlers. Infants/toddler food items were labeled and stored properly. Food preparation areas were toured for safety, cleanliness and proper equipment. A review of cleaning and food supply storage areas was made.

Report continued on page 2:
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3395
LICENSING EVALUATOR NAME: Alanda RicksTELEPHONE: (323)981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2016
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MARY ALICE O'CONNOR CCLC
FACILITY NUMBER: 198013177
VISIT DATE: 09/20/2016
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Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.
Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met appropriately. Staff was questioned to establish their familiarity of emergency reporting requirements, emergency disaster plans and other site operations.

Sign in and out sheets and procedures were reviewed with staff, policy of checking children for illnesses. Personal Rights of children were discussed and observed by LPA. Children were interviewed for general observations of facility operation. Staff and children records were reviewed for completeness including but not limited to Criminal Record Clearances for adults, Assistant Director Qualifications and verification of CPR/First Aid.
  • 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. The Day care center shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the facility.

LPA advised how to access forms and regulations on line at www.ccld.ca.gov.

Licensee is required to adhere to the terms and limitation as stated on the license.

No deficiencies were observed or cited in accordance to Title 22 of the California Code of Regulations on this date.

Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months that documents a Type A citation-this includes facility visits and substantiated complaint investigations. Licensee should provide copies of Licensing report, and obtain signed LIC9224 for each child's file, if or when above is cited.

Recent regulatory changes were discussed (including SB 933). Exit interview was conducted with Amanda Edwards, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3395
LICENSING EVALUATOR NAME: Alanda RicksTELEPHONE: (323)981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2016
LIC809 (FAS) - (06/04)
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