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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005652
Report Date: 04/17/2025
Date Signed: 04/17/2025 02:58:04 PM

Document Has Been Signed on 04/17/2025 02:58 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DOLPHIN PARKFACILITY NUMBER:
198005652
ADMINISTRATOR/
DIRECTOR:		AULAI, LILIUFACILITY TYPE:
840
ADDRESS:21205 S. WATER ST.TELEPHONE:
(310) 549-4560
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 49TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
04/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Director, Lynne AinuuTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced annual required inspection at the above facility. Currently the school-age program is closed for spring break. From 04/14/25 to 04/18/25 facility is has "exemption from licensure 101158(7)(A)2" and will go back to regular schedule 04/21/25. LPA met with Facility Representative (FR) Lyanne Anniuu who guided analyst on a tour of the facility. There were zero school aged children present. There were four staff present when LPA arrived. The program currently operates Monday thru Friday from 2:45pm to 6:00pm.

Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 04/15/25. LPA observed required licensing documents posted on bulletin board. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed material and equipment are free of sharp, loose, or pointed parts. Telephone service, heating, lighting and ventilation were evaluated. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. Bathrooms were observed to be gender specific and they provide individual privacy for children. General sanitation was observed. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children.

According to the Director, no medication is administered. Facility Representative understands that storage areas for poisons must be locked with a key or combination lock. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. First Aid supplies were observed and up to date. All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

NAME OF LICENSING PROGRAM MANAGER: Valarie Cook
NAME OF LICENSING PROGRAM ANALYST: Susann Sanchez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2025
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DOLPHIN PARK
FACILITY NUMBER: 198005652
VISIT DATE: 04/17/2025
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Children bring their own water in their personal water containers. There is also a purified water fountain available for children to refill their water container. LPA did not observe facility to be lead tested and no records were found in the Child Care Center Lead Sampling website. Facility may qualify to be exempt, LPA provided PIN 21-21 and LPA will return if needed. Director stated that building was tested for lead and is working on providing documentation. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight fitting covers that are kept on, and in good repair. All foods/beverages are stored in covered containers at 45˚ (F) or less.

Facility is located in a public park. LPA advised that no children shall be left without the supervision of a teacher at any time. Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. Areas around and/or under climbing equipment, swings and slides have cushioning material to absorb a fall. The outdoor area had adequate shade. LPA did not observe any bodies of water during this visit. Director states there are no weapons or firearms on the premises.

Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and LIC 613A Personal Rights.



Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.
NAME OF LICENSING PROGRAM MANAGER: Valarie Cook
NAME OF LICENSING PROGRAM ANALYST: Susann Sanchez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DOLPHIN PARK
FACILITY NUMBER: 198005652
VISIT DATE: 04/17/2025
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Fabian Renteria.
NAME OF LICENSING PROGRAM MANAGER: Valarie Cook
NAME OF LICENSING PROGRAM ANALYST: Susann Sanchez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC809 (FAS) - (06/04)
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