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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007432
Report Date: 03/12/2024
Date Signed: 03/12/2024 03:32:28 PM

Document Has Been Signed on 03/12/2024 03:32 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:BUNDLE OF JOY DAYCARE #3FACILITY NUMBER:
198007432
ADMINISTRATOR:YOLANDA STOWEFACILITY TYPE:
850
ADDRESS:4835 LONG BEACH BLVD.TELEPHONE:
(562) 728-6882
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 45TOTAL ENROLLED CHILDREN: 17CENSUS: 10DATE:
03/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Substitute Director - Olivia BelgerTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management visit on 03/12/24 at 2:50 PM. LPA was met by Substitute Director, Olivia Belger, who guided analyst on a tour of the facility. LPA observed 4 additional adults and 11 napping children. The purpose of this visit is to observe corrections to citations issued during a required 3 year annual visit on 02/29/24

LPA observe staff files for adults present during inspection. LIC 9052 - employee rights, were observed in each file as well as LIC 503 - Health Screening Report. Per S1, a doctor's appointment has been scheduled for late April 2024 to have LIC 503 completed and have TB tests re-administered. Per S1, the facility drinking water is scheduled for lead testing on 03/20/24. LPA observed that cleaning solutions and disinfectant wipes have been properly stored and made inaccessible to children in care. The kitchen area was observed to be clean and free of defects. No cleaning supplies were observed in the same area where food is stored. S1's transcripts were observed in the personnel folder and are available for review.

LPA observed that the outdoor play area has exposed screw heads on the playground in a piece of wood that is painted yellow. LPA advised S1 that a citation under California Code of Regulation (CCR) section 101238.2(d)(1) will be issued.

LPA generated cleared POC letters for citations that were observed to have corrections. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the substitute Director Olivia Belger
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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Document Has Been Signed on 03/12/2024 03:32 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/12/2024 at 03:10 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: BUNDLE OF JOY DAYCARE #3
FACILITY NUMBER: 198007432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
CCR
101238.2(d)(1)

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(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
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POC visit
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Based on observation, interview and record review, the facility did not remove exposed screws from a piece of wood painted yellow in the outdoor play area which poses and potential Health, safety and/or personal rights risk to persons in care.
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024


LIC809 (FAS) - (06/04)
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