Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018022
Report Date: 01/13/2017
Date Signed 01/13/2017 04:09:18 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:LEARN, PLAY AND GROWFACILITY NUMBER:
198018022
ADMINISTRATOR:HALLADJIAN, VIRGINEFACILITY TYPE:
850
ADDRESS:1000 E. ROUTE 66 #DTELEPHONE:
(626) 610-2626
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:45CENSUS: 18DATE:
01/13/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:JOYCE OLAERTIME COMPLETED:
04:30 PM
NARRATIVE
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A unannounced Random site Inspection was conducted on this date, by Cynthia Reyes, LPA. All areas identified on the Facility Sketch were inspected and checked the following: Fingerprint 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. Napping equipment and bedding was inspected for good condition, appropriate storage and cleanliness. Bedding identification were inspected. Storage for children's belongings and an isolation area with a sink, toilet, and mats/cots was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperatures, toilet paper, 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 testing.) Incidental Medical Services was discussed. 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. Facility Days and Hours are: M-F 6:30AM - 6:00PM
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2017
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 4


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: LEARN, PLAY AND GROW
FACILITY NUMBER: 198018022
VISIT DATE: 01/13/2017
NARRATIVE
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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
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2017
LIC809 (FAS) - (06/04)
Page: 4 of 4


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: LEARN, PLAY AND GROW
FACILITY NUMBER: 198018022
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2017
Section Cited
ยง1596.841
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CURRENT ROSTER OF CHILDREN PROVIDED CARE IN FACILITY REQUIRED
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The facility did not have a current or past roster of children in care.
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Director stated will complete a roster and send proof by the POC date.

LIC 9040 Children's Roster was provided to the Director on this date.
Type B
01/20/2017
Section Cited
101217(a)
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Personnel Records.
Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. Facility was unable to provide LPA with a current copy of the Personnel Report (LIC 500) during today's visit
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Director stated she will submit the current copy of the Personnel Report (LIC 500) to LPA by the POC due date.
Type B
01/20/2017
Section Cited
101174
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Disaster and Mass Casualty Plan Disaster drills shall be conducted at least every six months. The drills shall be documented. This documentation shall be kept in the child care center for at least one year. Director states drills are practiced but not docuemnted.
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Director states she will conduct fire and earthquake drills and will document. Send proof by the POC date
Type B
01/20/2017
Section Cited
101238(a)
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Buildings and Grounds
The child care center shall be in good repair at all times to ensure safety and well-being of children, employees and visitors.
One of the children toilet next to the office is not working.
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Director states she will have the toilet fixed and send proof by the POC date.
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: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2017
LIC809 (FAS) - (06/04)
Page: 3 of 4


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: LEARN, PLAY AND GROW
FACILITY NUMBER: 198018022
VISIT DATE: 01/13/2017
NARRATIVE
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AM/PM Snack, (Children bring own 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. No Transportation policy and procedures were reviewed for safety requirements. 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. Children and Staff confidential name report (lic 811) was given and documented on this date. No weapons or bodies of water on premises. The smoke detectors, carbon monoxide & fire extinguisher are in operable condition.

The following deficiencies were observed in accordance to Title 22 of the California Code of Regulations. See 809D page Consultation was conducted on this date.

Recent regulatory changes were discussed (including SB 933). 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: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2017
LIC809 (FAS) - (06/04)
Page: 2 of 4