Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370966
Report Date: 07/06/2017
Date Signed 07/06/2017 11:56:13 AM

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. OLAF CHILDCARE CENTERFACILITY NUMBER:
304370966
ADMINISTRATOR:WISHART, KARENFACILITY TYPE:
830
ADDRESS:12432 NINTH STREETTELEPHONE:
(714) 530-8930
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:20CENSUS: 9DATE:
07/06/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Karen WishartTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An inspection was conducted at the facility by LPA Dean Valencia. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Operating hours are 7am to 6pm, Mon-Fri. The facility was toured inside and outside and the floor and yard plan were verified. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. This is a combination center with a separate preschool license. The facility has a separate Toddler Component conducted in the 'Green Room'. Activity space for infants is separate from other age groups. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were inaccessible to children. Poisons/hazardous items are locked in a maintenance closet. The toys, floors and other equipment appeared clean, safe and age appropriate for infants. There is sufficient napping equipment. Bedding is laundered daily, on-site. The changing table is within arm’s reach of a sink, and appears clean and sanitary. A current menu was posted. Food prep areas appear clean and sanitary. Food is properly stored. Bottles and food containers brought from home are properly labeled with name and date. Garbage cans containing solid waste have tight fitting lids. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the facility. The playground is completely fenced and free of hazards. The playground equipment appeared in safe condition. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. Children and staff records were reviewed and within compliance. Infant Needs and Services/Feeding Plans were reviewed, are within compliance and being updated quarterly. The sign in/out procedure was reviewed and in compliance. At least one staff member present possessed current CPR/First Aid certifications, which expire 7/2018. 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. (continued on LIC809C).
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2017
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 2


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. OLAF CHILDCARE CENTER
FACILITY NUMBER: 304370966
VISIT DATE: 07/06/2017
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 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. Proof of immunization's against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. All licensing reports are public information and must be made available upon request. This report was reviewed and discussed with the licensee. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative. English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The director/licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years.
There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2