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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015952
Report Date: 09/13/2023
Date Signed: 09/13/2023 11:43:25 AM

Document Has Been Signed on 09/13/2023 11:43 AM - 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:BETHANY MANOR DEVELOPMENT AND LEARNING CENTERFACILITY NUMBER:
198015952
ADMINISTRATOR:RENEE KOSKAFACILITY TYPE:
850
ADDRESS:15415 S. PIONEER BLVD.TELEPHONE:
(562) 868-1517
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 64TOTAL ENROLLED CHILDREN: 35CENSUS: 23DATE:
09/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director Renee Koska TIME COMPLETED:
11:50 PM
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On 9/13/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection. LPA met with Director Renee Koska and informed her of the purpose of the visit. LPA provided Facility Entrance Checklist to Director. The facility was observed to be within the license capacity and limitations. Upon arrival there were 10 children with three staff in the language class-Room 15, and 10 children with 3 staff in the nutrition/music room. Criminal Record Clearances for staff present was verified. Operating hours are Monday, Wednesday and Friday 9 AM to 12 PM. The facility provides services to children ages 2 to entry into first grade.
This is a full inclusion center based program. Children are grouped according to their developmental levels. The groups rotate among the classrooms throughout the 3 hour session. The classrooms focus on different developmental domains. Classrooms used in the facility are 11-Gross motor, 13-Fine Motor, 14-Cognitive, 15-Language and the snack room.
All areas 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. There is cental air/heating in the facility. Children have their own cubbies in the hallway to store their belongings. The main office is used as the isolation area for ill children waiting to be picked up. The isolation restroom is the staff restroom in the office. There are two restrooms available for children in the facility. The main restroom has two toilets, two sinks and two diaper changing tables and the second restroom has three toilets and two sinks. General sanitation was observed in the children's restrooms. The facility offers potty training.
Availability of indoor drinking water was observed in classrooms via bottled water. Per Director, disposable cups are used and staff assist children if needed. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Cleaning supplies are stored in shelves above the sinks. Medication is stored in the refrigerator if needed and in a locked box in the main office. Per Director, children enrolled do not require medication during the hours they are present. There is at least one operable carbon monoxide detector in the facility. The facility has a central fire alarm installed. Each class contains a first aid kit. First aid kit were inventoried.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: BETHANY MANOR DEVELOPMENT AND LEARNING CENTER
FACILITY NUMBER: 198015952
VISIT DATE: 09/13/2023
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There are no firearms stored on the premises. There are no pools or bodies of water at the facility. There is a 2A10BC fire extinguisher in each classroom. Fire extinguishers were last serviced in 12/2022. There is no nap time offered due to this being a half day program.
Children’s Records were reviewed for completeness. Children's records contained all required forms.
Staff records were reviewed. Three out of nine staff records reviewed did not contain verification of educational requirements.
Children's roster was reviewed. Sign-In and Sign-Out sheets were reviewed. A disaster drill log was available. Last drill documented was held on 7/17/23.
Parents provide snack for children due to dietary restrictions and the facility also has snack items available if needed. Menus are provided to parents/ authorized representatives four months in advance and the menus are also posted. Menus for the past 30 days are available upon request.
All 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 shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags shall be discarded immediately after each meal. Currently there are two children enrolled with food allergies. A food allergy list is posted in the snack room.
The outdoor playground area was evaluated. The outdoor playground is fully fenced. Outdoor equipment is in a safe condition, free of sharp, loose or pointed parts. All areas around or under high climbing equipment and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. There is a play structure in the play yard. Per Director, the program mainly uses the Gross Motor Classroom-room 11, for gross motor activities.
Incidental Medical Services (IMS) policy was discussed. There are no children currently enrolled who require medication at the facility. 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.htm
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
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: BETHANY MANOR DEVELOPMENT AND LEARNING CENTER
FACILITY NUMBER: 198015952
VISIT DATE: 09/13/2023
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Facility Representative 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/facility representative how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.
LPA informed Director of the importance of checking for recalled 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.
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/tion-process.
No deficiencies cited today.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and Appeal Rights and report were reviewed with Director Renee Koska .
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023
LIC809 (FAS) - (06/04)
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