Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370721
Report Date: 05/08/2017
Date Signed 05/08/2017 03:14:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ST. NORBERT CATHOLIC SCHOOL CHILDREN'S CENTERFACILITY NUMBER:
304370721
ADMINISTRATOR:APOLLO, KRISTINAFACILITY TYPE:
850
ADDRESS:300 EAST TAFT AVENUETELEPHONE:
(714) 637-6822
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:36CENSUS: 33DATE:
05/08/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Kristina Rogers ApolloTIME COMPLETED:
01:30 PM
NARRATIVE
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(3) An unannounced Annual inspection was conducted today by Licensing Program Analysts (LPA), Mahnaz (Nancy) Malek and LPA Wendy Port who met with the director, Kristina Rogers Apollo. The facility was inspected inside and out with the director. Census was taken and there were a total of 33 preschool children with 4 staff members. There were 24 children on the playground with 3 staff members and 9 children with 1 staff member in the classroom (monkey room). A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility is equipped with Carbon Monoxide Detector. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Upon inspection of the monkey room there was bleach labeled "danger" observed in the upper cabinet. The bleach was not accessible to children, however it was not locked. There were no locks on the cabinet where the bleach was stored. (Bleach with a danger label is considered poison and they shall be locked. Upon further inspection of the monkey room LPAs also observed a sharp knife located in a drawer adjacent to the refrigerator. The knife was accessible to children. In the ministry classroom LPAs observed poison (insecticide) located on the top shelf of an unlocked cabinet. Equipment and furniture was inspected to ensure it's in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. The food preparation area was inspected for cleanliness, free of rodents/vermin, appropriate storage of food, and verification of posted menus. Children bring their own snacks and lunches to school. There are no weapons, firearms or bodies of water in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (MMR, Pertussis, and Flu vaccines. A sample of children's files were reviewed for completeness of admission agreement, verification of sign in/out including time the child was signed in/out by authorized representative as well as verification of representatives full legal signature. Continued on page 2
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2017
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ST. NORBERT CATHOLIC SCHOOL CHILDREN'S CENTER
FACILITY NUMBER: 304370721
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2017
Section Cited
101238(g)(1)
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Buildings and Grounds. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children shall be inaccessible to children. Storage areas for poisons shall be locked. Bleach labeled "danger" and insecticide were observed in unlocked cabinets. This poses and immediate health and safety risk to children.
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The facility representative plans to resolve the violation by placing all poisons in a locked cabinet. The facility will send a written plan how she would take care of the situation by the due date.
Type A
05/09/2017
Section Cited
101238(a)
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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times. There was a sharp knife and metal fasteners accessible to the children in two different drawers in Monkey room. This poses an immediate Health and Safety risk to the children in care.
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The facility representative plans to resolve the violation by moving the knife a metal fasteners to a storage area inaccessible to the children. The facility will send a written plan with all the staffs' signatures acknowledging proper storage of hazardous items by the due date.
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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: Rina LopezTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2017
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ST. NORBERT CATHOLIC SCHOOL CHILDREN'S CENTER
FACILITY NUMBER: 304370721
VISIT DATE: 05/08/2017
NARRATIVE
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The facility does provide Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment /supplies, and reviewed children's, personnel, and administrative records. The facility currently have children with medications. For IMS information see Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800)514-0383 (TTY) and link to publication: Commonly AskedQuestions about Child Care Centers and the ADA, available at http://www.ada.gov/child qanda.htm.
The facility representative was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also
informed that the LICE 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC 9182). Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org
The following website link for infant's safe sleep information in English and Spanish were given. www.cdph.ca.gov/programs/sids/documents/sidschildcaresafesleep.pdf (In Spanish language)
www.cdph.ca.gov/programs/sids/documents/childcareprovsleepspan2011.pdf (In English language)
A copy of child care provider's guide to safe sleep pamphlet was given to the staff member.
A copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org was given to the facility representative.The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The licensee was provided a copy of their appeal right (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates. Exit interview was conducted. In the areas that were evaluated, the following violations of the California Code of Regulations, Title 22; Division 12, were observed: 101238(g)(1) and 101238(a) see LIC 809D. Upon receipt, licensee shall post and provide copies of this report to parents/
Guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee may use Lic. 9224 for this purpose.This report ends here.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2017
LIC809 (FAS) - (06/04)
Page: 2 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ST. NORBERT CATHOLIC SCHOOL CHILDREN'S CENTER
FACILITY NUMBER: 304370721
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2017
Section Cited
H & S 1596.622
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Employees or volunteers at day care center; immunization requirements; records; exemptions:
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 Influenza.
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The facility representative stated she would arrange for staff to have the required immunization and will send the verification of the date vaccine administered to our office by the due date.
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Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. Two staff did not have MMR verification on file. One staff did not have verification of influenza (flu) shots (or declined statement) Names were given. This is a potential hazard to the safety of children.
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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: Rina LopezTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2017
LIC809 (FAS) - (06/04)
Page: 4 of 4