198014170-11-2-2023-33-CC-TRAO-CX822N-20231102170058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014170
Report Date: 11/02/2023
Date Signed: 11/02/2023 05:01:10 PM

Document Has Been Signed on 11/02/2023 05:01 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	KIDS KLUB SAN GABRIEL / ROSEMEAD		FACILITY NUMBER:	198014170
ADMINISTRATOR:	MARY PERALTA		FACILITY TYPE:	830
ADDRESS:	4930 EARLE AVENUE		TELEPHONE:	(626) 288-4400
CITY:	ROSEMEAD	STATE: CA	ZIP CODE:	91770
CAPACITY: 19	TOTAL ENROLLED CHILDREN: 19	CENSUS: 9	DATE:	11/02/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Maria Rennard, Director		TIME COMPLETED:	01:00 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	Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Required 3-year inspection. Licensing Staff met with Director Maria Rennard and stated the purpose of the visit. LPA provided Director with a copy of the Entrance Checklist for Child Care Centers form (LIC 125). A COVID 19 risk assessment was conducted prior to entering the facility. This is an infant program with 2 other licenses: Preschool Program #198014168 & School age #198014169. Hours of Operation: Monday through Friday, 7AM to 6PM. There are no shared areas between the programs. LPA observed the programs to be physically separated both indoors and outdoors. This infant program consists of 3 classrooms: Guppies room was designated as the napping room with 5 cribs and mats for older infants. No infants at the time of inspection. Turtles #1 - 5 infants with 2 teachers and 1 associate. Turtles #2 - 4 infants with 1 teacher and 1 associate. LPA observed the changing table and feeding chairs to be operational condition. There is a sink located within arm’s reach of the changing table. LPA observed the designated napping area 5 cribs and mats which are available for the older infants to nap. Storage for children's belongings were inspected. LPA observed each child to have their own cubbies. Formula pre-mixed milk is provided by the parents. LPA observed that all food brought from home contains the child’s name and stored in the refrigerator. Licensing staff observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. There are age-appropriate toys and supplies for children in the classroom, in good repair. Page 1 of 3

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDS KLUB SAN GABRIEL / ROSEMEAD	FACILITY NUMBER: 198014170
	VISIT DATE: 11/02/2023

NARRATIVE

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The facility was observed to have diapers and wipes available in the changing area. Drinking water is available in the form of purified water that are also taken outside via water container. Facility use water from the filtered faucets for rinsing dishes, milk bottles and others. At this time, the Director's Office is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff ensure that children with obvious symptoms of illness are not being accepted.
The facility provides breakfast, lunch, morning and afternoon snacks for infants. All food preparation are done in the preschool kitchen. All storage containers for solid waste, including movable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. The facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The facility takes measures to keep the facility free of flies, other insects and rodents.

LPA observed it to be physically separated from the preschool outdoor play yard. Outdoor play equipment is in good condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe and is free of hazards.

Staff Records were reviewed to ensure that there is a staff with valid pediatric first aid/CPR during business hours. Mandated reporter training certification is on file. Criminal Records Clearance for staff were reviewed.
Children’s Records were reviewed to ensure that required forms are on file. Needs and Services Plan for infants were updated quarterly.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KIDS KLUB SAN GABRIEL / ROSEMEAD	FACILITY NUMBER: 198014170
	VISIT DATE: 11/02/2023

NARRATIVE

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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

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

Analyst reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Care Centers (CCCs) with facility director during the inspection. Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing. Per Director, lead testing was completed and facility passed the testing. Copy of LIC9225, LIC9226, LIC999 and lab reports were obtained during this visit.

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/inspection-process.

There were no deficiencies cited under California Code of Regulations Title 22 during this visit. 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 with the Director. Copy of report and Appeal Rights were given.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE:	DATE: 11/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC809 (FAS) - (06/04)

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