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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012363
Report Date: 06/14/2022
Date Signed: 06/14/2022 05:20:36 PM

Document Has Been Signed on 06/14/2022 05:20 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:YOUNG PEOPLES VILLAGEFACILITY NUMBER:
198012363
ADMINISTRATOR:ANNETTE CLARKFACILITY TYPE:
850
ADDRESS:6051 N. ROSEMEAD BLVD.TELEPHONE:
(626) 287-2114
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY: 131TOTAL ENROLLED CHILDREN: 131CENSUS: 112DATE:
06/14/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Gracie Chavez, DirectorTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst’s (LPAs) Fabiola Vasquez and Veronica Martinez conducted an unannounced annual required continuation inspection at the above facility on 06/14/22 at 12:30 PM. LPAs met with Gracie Chavez, Director who guided analysts on a tour of the facility at approximately 12: 35 PM. LPAs observed in.
1A: 1 staff/children10, 1B: 1 staff/children 11,1C: Classroom closed, 2A: 1 staff/children10, 2B: 1 staff/children10, 3A: 1 staff/children10, 3B: 1 staff/children10, 4A: 1 staff/children 09, 4B: 1 staff/children 09, 51A1: 1 staff/children 09, 51A2: 1 staff/children 08, 51B1: 1 staff/children 08, 51B2: 1 staff/children 08. Total census: 112 children with 12 staff.

Inspection Continuation conducted on 06/09/22.

At approximately 1:50 PM Licensing Program Analyst (LPA) Fabiola Vasquez observed not all chilren wer observed to be napping. during nap time that children were not all asleep. LPA observed 1 to 3 children awake being supervised with one teacher.

2A and 2B there were a total of 22 children with 1 staff,
3A and 3B there were a total of 18 children with 1 staff,
51A1 and 51A2 there were a total of children 18 with 1 staff,
51B1 and 51B2 there were a total of 18 children with 1 staff. Teacher-child ratios were observed not to be in accordance with Title 22 regulations. Licensee is not within the conditions, limitations, and capacity specified on the license. Total census: 87 children with 7 staff.

LPA clarified the classroom numbers observed noted on the LIC 809

PAGE 1 OF 4
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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 7
Document Has Been Signed on 06/14/2022 05:20 PM - It Cannot Be Edited


Created By: Fabiola Vasquez On 06/14/2022 at 04:15 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: YOUNG PEOPLES VILLAGE
FACILITY NUMBER: 198012363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101230(c)
Activities/Napping
(c) A teacher-child ratio of one teacher supervising 24 napping children is permitted provided that the remaining teachers necessary to meet the overall ratio specified in Section 101216.3(a) are immediately available at the center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation durining nap time in 2A and 2B there were a total of 22 children with 1 staff, 3A and 3B there were a total of 18 children with 1 staff, 51A1 and 51A2 there were a total of children 18 with 1 staff, 51B1 and 51B2 there were a total of 18 children with 1 staff. Teacher-child ratios were observed not to be in accordance with Title 22 regulations.which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2022
Plan of Correction
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Per Director she had a meeting with all her staff to discuss the coverage incident and adjusted the lunch breaks by staggering them. Also hired a new teacher. Director provided a personnel schedule.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claudia Guangorena
LICENSING EVALUATOR NAME:Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 06/14/2022 05:20 PM - It Cannot Be Edited


Created By: Fabiola Vasquez On 06/14/2022 at 04:15 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: YOUNG PEOPLES VILLAGE
FACILITY NUMBER: 198012363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(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:
Deficient Practice Statement
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Based on LPA observed at 2:30 PM LPA observed in the young preschool a wooden fence barricading the air conditioning to have missing wooden panels. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2022
Plan of Correction
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Per director she had her handy man come in to inspect the fence, will submit proof to LPA by POC date.
Type B
Section Cited
CCR
101229(a)
Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation on 6/9/22 at 2:10 a child was coming out from the restroom from 51B1/51B2 were there were a total of 18 children with 1 staff, LPA observed an additional door in the restroom leading to the outside yard. Child was not observed to be under visual supervision from a teacher poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2022
Plan of Correction
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Per Director she had a meeting with all her staff to discuss the coverage incident and adjusted the lunch breaks by staggering them. Also hired a new teacher. Director provided a personnel schedule.
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:Claudia Guangorena
LICENSING EVALUATOR NAME:Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022


LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 06/14/2022 05:20 PM - It Cannot Be Edited


Created By: Fabiola Vasquez On 06/14/2022 at 04:15 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: YOUNG PEOPLES VILLAGE
FACILITY NUMBER: 198012363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) 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 measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs record review staff S1, S3, S6 were missing proof of Tdap, Staff S1, S3, S4, S6, S8, S9 were missing proof of MMR, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2022
Plan of Correction
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Per licensee she is going to fax proof to LPA by POC date.
Type B
Section Cited
CCR
101229.1(d)
Sign In and Sign Out
(d) The sign-in and sign-out sheets with the signatures required by this section and by Section 101226.1 shall be kept for one month and shall be available at the center for review by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review LPA observed there were 87 children attending on 6/9/22. LPA reviewed the sign in and out signatures, 20 children present were missing signatures. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2022
Plan of Correction
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Per Director she had a meeting with her staff individually to inform them to hold the sig in and sign out sheets to insure that the parents are signing.
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:Claudia Guangorena
LICENSING EVALUATOR NAME:Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022


LIC809 (FAS) - (06/04)
Page: 4 of 7
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: YOUNG PEOPLES VILLAGE
FACILITY NUMBER: 198012363
VISIT DATE: 06/14/2022
NARRATIVE
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On 6/9/22 at 2:10 LPA observed a child coming out from the restroom in 51B1 and 51B2 were there were a total of 18 children with 1 staff, LPA observed an additional door in the restroom leading to the outside yard. Child was not observed to be under visual supervision from a teacher. Staff names were recorded. Criminal Record Clearances were reviewed.

LPA observed required forms to be posted on the Parent Board located near entrance of facility. LPA observed the following: Facility License, LIC 613A Personal Rights, PUB 269 Child Car Seat Poster, PUB 369 Notification of Parent's Rights, and LIC 610 Emergency Disaster Plan. LIC 9148 Earthquake Preparedness and Verification of Disaster and Fire Drills were reviewed dated: 05/11/22.

LPA observed the facility to be clean, safe at 2:30 PM LPA observed in the young preschool a wooden fence barricading the air conditioning to have missing wooden panels. Sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All surfaces and materials accessible to children, including toys, are toxic free. All toilets and hand washing facilities are in safe and sanitary operating conditions. At this time, the director’s office is used as the isolation room. Children are using the staff restroom. Parents are contacted immediately when children are determined to be ill, and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Snack menus was not observed, per director school provides breakfast, lunch and snack.

LPA observed individual water containers that children bring from home. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children in the lounge. Storage areas for poisons are locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Fire extinguisher ex-date: 4/16/22.

Outdoor play equipment was observed to be in good condition, free of sharp, lose or pointed parts. LPAs observed age appropriate toys and equipment for children in care. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Director states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this. Director states there are no weapons or firearms on the premises. PAGE 2 OF 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: YOUNG PEOPLES VILLAGE
FACILITY NUMBER: 198012363
VISIT DATE: 06/14/2022
NARRATIVE
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Director 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.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.



Deficiencies are being cited on today’s visit. See LIC 809D.

LPAs informed Director Gracie Chavez, that this report dated 06/14/22 documents # 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs informed the licensee to director a copy of this licensing report dated 06/14/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Gracie Chavez.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: YOUNG PEOPLES VILLAGE
FACILITY NUMBER: 198012363
VISIT DATE: 06/14/2022
NARRATIVE
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Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. LPA observed there were 87 children attending on 6/9/22. LPA reviewed the sign in and out signatures, 20 children present were missing signatures.

Staff Records were reviewed and discussed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, health preventive practices documented, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights. Staff (S) missing proof of Tdap: S1, S3, S6. Staff (S) misssing proof of MMR: S1, S3, S4, S6, S8, S9.



Children’s Records were reviewed and discussed to ensure that the following are present: LIC 613A Personal Rights, Admission Agreement, LIC 700 Identification and Emergency form, LIC 701 Physician’s Report, LIC 995 Notification of Parent’s Rights, LIC 627 Consent for Emergency Medical Treatment and Immunization Record.

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. 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.html

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.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
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