Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017951
Report Date: 06/29/2015 12:00:00 AM
Date Signed 06/30/2015 05:12:22 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:GRANDVIEW HOUSE PRESCHOOLFACILITY NUMBER:
198017951
ADMINISTRATOR:HAIEK, LENAFACILITY TYPE:
850
ADDRESS:1212 N. PACIFIC AVE.TELEPHONE:
(818) 246-8101
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY:60CENSUS: 36DATE:
06/29/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Lena HaiekTIME COMPLETED:
06:00 PM
NARRATIVE
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An unannounced Annual/Random visit was conducted on this date, by Alanda Ricks, Licensing Program Analyst (LPA). Met with Lena Haiek, Director, who guided analyst tour of the facility.
All areas identified on the Facility Sketch were inspected and checked the following: Classrooms: Monkey room #1, 2 and
Lion room were inspected. LPA have asked director if she provides Incidental Medical Services to enrolled children. She stated she has a child who has asthma and she does provide Incidental Medical Services-IMS. LPA has instructed licensee to submit her plan of operation implementing IMS within 30 days.
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. 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. First Aid supplies were inventoried. 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 test.
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. Food preparation areas were toured for safety, cleanliness and proper equipment. A review of cleaning and food supply storage areas was made. 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, Director Qualifications and verification of CPR/First Aid and health preventive practices documentation. Inspection of required forms was made.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Alanda RicksTELEPHONE: (323)981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2015
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: GRANDVIEW HOUSE PRESCHOOL
FACILITY NUMBER: 198017951
VISIT DATE: 06/29/2015
NARRATIVE
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Once licensed Licensee is required to adhere to the terms and limitation as stated on the license.

The following deficiencies was observed or cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes.

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 will provide copies of Licensing report, and obtain signed LIC9224 for each child's file, when or above is cited.

WEB SITE ADDRESS is (www.ccld.ca.gov). Issued handbook on Child Abuse Reporting, Never Shake a Baby, and SIDS.


Recent regulatory changes were discussed (including AB 633-Parent Notification and AB 2865-Healthy Schools Act Pesticide Use Requirements), AB 978 Zero Tolerance deficiencies. Exit interview was conducted including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Alanda RicksTELEPHONE: (323)981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2015
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: GRANDVIEW HOUSE PRESCHOOL
FACILITY NUMBER: 198017951
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2015
Section Cited
101215.1
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CHILD CARE CENTER QUALIFICATIONS AND DUTIES:
LPA observed that staff #1 do not have transcripts/education was not available to review.
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Per licensee she will complete file with education/transcript by POC date 07/10/2015.
Type B
07/17/2015
Section Cited
101216.1 (a)
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TEACHER QUALIFICATIONS AND DUTIES:

LPA observed that staff 2 and 3 did not have education/transcripts on file to verify qualifications.
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Per licensee she will complete file with education/transcripts by POC date 07/10/2015.
Type B
07/10/2015
Section Cited
101216 (g)(1)
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PERSONNEL REQUIREMENTS:

LPA observed that staff #2 do not have health screening on file.
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Per licensee she will compete staff file with health screening by POC date 07/10/2015.
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Alanda RicksTELEPHONE: (323)981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2015
LIC809 (FAS) - (06/04)
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