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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191503656
Report Date: 03/22/2022
Date Signed: 03/22/2022 12:48:50 PM

Document Has Been Signed on 03/22/2022 12:48 PM - It Cannot Be Edited

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:FAITH DAYCARE CENTERFACILITY NUMBER:
191503656
ADMINISTRATOR:BALANDRAN, GAILFACILITY TYPE:
850
ADDRESS:505 EAST BONITA AVENUETELEPHONE:
9095990783
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 58TOTAL ENROLLED CHILDREN: 38CENSUS: DATE:
03/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Nancy LiraTIME COMPLETED:
01:00 PM
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On 3/22/2022 Licensing Program Analysts (LPAs) Jennifer Hua and Carolyn Tuba, conducted an unannounced 1 year annual inspection on this date. LPAs met with Director, Nancy Lira and a copy of the Entrance Checklist for Child Care Centers form (LIC 125) was provided. A Covid-19 risk assessment was conducted prior to entering the facility.

The facility shares the campus with a church. There are a total of 3 classrooms designated for the preschool program. Hours of operation are Monday-Thursday 7:30 am - 6:00 pm

8:45 AM The tour began at the school office where LPAs were guided into classroom A (Butterfly Classroom)

LPAs observed parents sign the child in/out located on an outside board of the entrance of the Butterfly classroom door. Use of hand sanitizer was available.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were observed to be inaccessible to children. Nancy states there are no poisons located at the facility. Carbon monoxide and smoke detectors were observed and are operable. Nancy stated there are no weapons or firearms on the premises.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: FAITH DAYCARE CENTER
FACILITY NUMBER: 191503656
VISIT DATE: 03/22/2022
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All areas identified on the Facility Sketch were inspected. The following was observed during the tour of the preschool classrooms. LPAs observed in Room A & B (Butterfly) there was one teacher with 11 students. Room C & Room D combined (Ladybugs and Honeybees) had 2 teachers and 9 children. Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision and observation, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Preschool children have their own cubby to store their personal belongings. LPAs observed napping mats was inspected to be in good condition, appropriate storage and cleanliness. Linens are washed daily and kept in the child's cubbie. The ill isolation area is located in the back office area of the lobby. Staff restrooms are located in the church building.

Menus were reviewed to ensure that they are being posted two weeks worth and visible to an authorized representatives. The facility provides morning and afternoon snack and lunch is brought from home by the parents. Drinking water is available indoors for each child with their own water bottle labeled with their name and Director was reminded to have water available outdoors as well. There is a water fountain outside and Director is going to clean out and have available for the children today, 3/22/2022.

Nancy was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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: FAITH DAYCARE CENTER
FACILITY NUMBER: 191503656
VISIT DATE: 03/22/2022
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Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857. LPA also reviewed Staff record, which were documented on the LIC 859. Staff present had proof against TB, measles, pertussis, and influenza, Mandated reporter has expired for all staff except for 2 teachers.

Director currently has CPR and Pediatric First Aid which expired 5/2020 during this inspection.

Medication: This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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) 514-0301 (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

Children's roster was reviewed and is current and number of total enrolled at this time was documented. Sign-In and Sign-Out sheets were reviewed. Children present were signed in correctly and accounted for on this date. Disaster drill log was available. The last fire and earthquake drill was conducted on 10/2021.

First Aid supplies were observed in the office. According to Staff, medication is only administered to a child when accompanied with a doctor's note and is stored in the kitchen in medication boxes labeled for each classroom.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
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: FAITH DAYCARE CENTER
FACILITY NUMBER: 191503656
VISIT DATE: 03/22/2022
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9 AM The outdoor playground was inspected and the play equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. LPAs did not observe any bodies of water on the premises. The preschool play yard is separated by a gate to ensure no commingling with the other components. The yards are called swing yard and bike yard that are seperated by a chain link fence.

Update: Effects of Lead Exposure and the following Provider Information Notices (PINs) Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD. were discussed.

Helpful Resources:
Access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

There were deficiencies cited on attached 809D during today’s inspection.

12:40 PM Exit interview conducted and report was reviewed with Nancy Lira Director.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/22/2022 12:48 PM - It Cannot Be Edited


Created By: Carolyn Tuba On 03/22/2022 at 11:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FAITH DAYCARE CENTER
FACILITY NUMBER: 191503656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.2(a)
Drinking Water
(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2022
Plan of Correction
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Per Director will be cleaning the fountain so water will be available outside.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in staff records which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/29/2022
Plan of Correction
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Per Director she will be scheduling to renew Certificate by the POC due date of 4/29/2022. Director will mail a copy to LPA.
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:Ana Chico
LICENSING EVALUATOR NAME:Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022


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