198015336-10-9-2023-33-CC-JHUA-CWFSW5-20231009141345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015336
Report Date: 10/09/2023
Date Signed: 10/09/2023 02:13:51 PM

Document Has Been Signed on 10/09/2023 02:13 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:	GOLDEN SPRINGS CHILD DEVELOPMENT CENTER, RM. 29		FACILITY NUMBER:	198015336
ADMINISTRATOR:	KYM ALLEN		FACILITY TYPE:	850
ADDRESS:	245 S. BALLENA DR.		TELEPHONE:	(909) 806-2392
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 29	CENSUS: 8	DATE:	10/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Bobby Guerrero, Teresita Van Gordon & Erika Mendez		TIME COMPLETED:	02:20 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	Random site inspection was conducted by LPA Jennifer Hua. LPA met with Associate Director, Bobby Guerrero, The program is housed on Golden Springs Elementary School in Room #29. This facility has one AM session from 7:30am -10:30 am and PM session 11:45am - 2:45pm five days a week. LPA observed 8 children in care supervised by 2 staff. All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. No napping period due to time sessions, Storage for children's belongings and an isolation area with sink, toilet, in the quiet area was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. A review of medication policy, including administering, labeling, storage, and records were made. Snack menus were reviewed. Food and snacks menus were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. Cleaning and food supply storage areas were also observed. Food is provided by the school district and brought over daily from school cafeteria. Outdoor equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. Children use the school's kindergarten playground Teacher child ratios were observed and staff names recorded. Teacher child ratio observed. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GOLDEN SPRINGS CHILD DEVELOPMENT CENTER, RM. 29	FACILITY NUMBER: 198015336
	VISIT DATE: 10/09/2023

NARRATIVE

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Sign and In sheet reviewed.

A review of children's records (Emergency Card) was reviewed. Staff and children records are located at the central office. Per staff, they are current in Pediatric CPR/First Aid training as well as the Mandated Reporter Training.

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

Deficiency cited on attached 809D

Exit interview was conducted, with Associate Director, Bobby Guerrero, copy of report given. Appeals rights procedure provided and explained.

Notice of Site Visit provided and explained. The notice shall be posted for 30 days.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/09/2023 02:13 PM - It Cannot Be Edited

Created By: Jennifer Hua On 10/09/2023 at 01:41 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: GOLDEN SPRINGS CHILD DEVELOPMENT CENTER, RM. 29	FACILITY NUMBER: 198015336
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above in the water lead testing has not been done as required which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/09/2023
	Plan of Correction
1 2 3 4	Per Associate Director, will correct and submit all required documents (LIC 9275, LIC 9276, facility sketch, photos, lead test result) to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jennifer Hua

LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC809 (FAS) - (06/04)

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