<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018354
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:46:12 PM

Document Has Been Signed on 05/18/2022 12:46 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:BEYOND OUR DREAMS INFANT CARE & PRE-SCHOOL,INCFACILITY NUMBER:
198018354
ADMINISTRATOR:KOUYOUMDJIAN, HASMIGFACILITY TYPE:
830
ADDRESS:416 N. ALTADENA DRIVETELEPHONE:
(626) 219-6277
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 24DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jasmine KouyoumdjianTIME COMPLETED:
12:53 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) Nolan Tcheng conducted an unannounced random annual inspection. Upon arrival at 9:30am, LPA met with Director Jasmine Kouyoumdjian. At 9:40am, LPA was led on a tour of the facility. This is an Infant program which consists of 2 classrooms, and a Toddler option with 1 classroom. Per licensee, there are currently 27 enrolled in the program. Hours of operation for this facility are 6:30am-5:30pm, Monday to Friday.

Licensing staff observed all required forms/publications to be posted in the office. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request.

PHYSICAL PLANT: At 9:40am, LPA entered and inspected Monkey Room: 7 children with 2 staff members, Tree Room: 8 children with 2 staff members, and Tigger Room (Toddler): 9 children with 2 staff members. The first room reviewed were for the young infants that are still mainly crawling. Cribs and napping equipment were observed in the infant program. LPA observed portable cribs that meet Consumer Product Safety Commission safety standards. Mattresses have an appropriate size mattress with a fitted sheet. Crib was observed to be free of loose items. In the Tree Room, cots were available for infants as they are able to climb out of a crib. Sleeping area is physically separated and cribs do not limit staffs ability to watch infants at all times. Per Director, bedding is changed daily. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. LPA observed the changing room for the infants in care. LPA observed the diaper changing table to be at least one inch thick, with raised sides of at least 3-inches, and within arms reach of the sink. Diapers for each child, lotions, gloves, and trashbins were observed adjacent to the area. LPA observed the toddler room which is physically separated from the infant areas. REPORT CONTINUES PAGE 1 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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 6
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: BEYOND OUR DREAMS INFANT CARE & PRE-SCHOOL,INC
FACILITY NUMBER: 198018354
VISIT DATE: 05/18/2022
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
26
27
28
29
30
31
32
At 9:45am, all food preparation areas and food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. Snacks were reviewed for availability, quantity and appropriateness to children in care. This facility provides breakfast, lunch, pm snack. LPA observed the facility fridge that has individually labeled bottles and items for infants in care. There is a drying rack next to the kitchen sink for the feeding bottles and there is a bottle warmer on the kitchen counter.

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. The facility was observed to be free of flies, other insects and rodents. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water was readily available indoors in the form of bottles. Facility fills the bottles with filtered water. At this time, the office is used as an isolation area. A cot is available for an ill child to rest on. First Aid supplies are available and complete. Director states there are no weapons, firearms, or bodies of water on the premises. The Toddler room is the only room utilizing toilets right now. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly.

At 9:55am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 07/20/2021, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Facility has a functioning carbon monoxide detector that meets statutory requirements.

At 10:05am, LPA reviewed the outdoor play area. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. This facility uses fake grass. There is one outside play space for the infants in care. There are small play structures and slides, along with age appropriate toys and equipment. There is shade above the area as well.. Another outside play space observed for the Toddler option. There is space for the children to run, a bike path, play structure, and small slides for the children to use. Drinking water is readily available outdoors.

Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher during tour.The Licensee is within the conditions, limitations, and capacity specified on the license. All areas were identified on the Facility Sketch were inspected. REPORT CONTINUES PAGE 2 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: BEYOND OUR DREAMS INFANT CARE & PRE-SCHOOL,INC
FACILITY NUMBER: 198018354
VISIT DATE: 05/18/2022
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
26
27
28
29
30
31
32
FACILITY RECORDS: 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. Disaster drills have been conducted at least every six months. Staff files were reviewed for a health screening report and immunizations that meet regulatory requirements. During review of Staff files, LPA observed that 2 of 8 staff files did not have an LIC503 Health Screening Report in their file. LPA discussed with the Director of ensuring that this form is completed and kept in file upon being hired to work with children. Review of Staff files also revealed that 4 of 8 staff files do not have complete immunization records present. Director was informed that potential Health and Safety risk that this presents to children in care. Criminal Record Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed. During review of required trainings, LPA observed that 3 of 8 staff files did not have proof of completion for Mandated Reporter Training. Director states that some of the staff have not renewed their training and that they will make sure staff completes it as soon as possible. A random sample of Children’s Records were reviewed to ensure that they are complete.

INCIDENTAL MEDICAL SERVICES:


This facility provides Incidental Medical Services –( IMS). Facility has submitted IMS plan for all locations. 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

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/ REPORT CONTINUES PAGE 3 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: BEYOND OUR DREAMS INFANT CARE & PRE-SCHOOL,INC
FACILITY NUMBER: 198018354
VISIT DATE: 05/18/2022
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
26
27
28
29
30
31
32
SAFE SLEEP:
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.

Licensee 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.

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

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted with Director Jasmine Kouyoumdjian, at 12:37pm, and Plan of Corrections were reviewed and developed. Copy of report was provided.

END OF REPORT PAGE 4 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 05/18/2022 12:46 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 05/18/2022 at 12:20 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: BEYOND OUR DREAMS INFANT CARE & PRE-SCHOOL,INC
FACILITY NUMBER: 198018354

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022

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
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 4 out of 8 staff files, Staff #2-4, & 8, did not have complete immunization records, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
1
2
3
4
Per Director, they will have Staff #2-4 & 8 obtain a copy of their immunization record for Pertussis, Measles, and Influenza, and will provide copies of the record to LPA by POC date.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 8 staff files, Staff #3, 5, &8, did not have proof of completion for Mandated Reporter Child Care Provider (AB1207) Training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/25/2022
Plan of Correction
1
2
3
4
Per Director, they will have Staff #3, 5, & 8 complete the Mandated Reporter Child Care Provider (AB12097) Training and will submit proof of completion to LPA by POC date.
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:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 05/18/2022 12:46 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 05/18/2022 at 12:20 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: BEYOND OUR DREAMS INFANT CARE & PRE-SCHOOL,INC
FACILITY NUMBER: 198018354

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 out of 8 staff files, Staff #3 & 8, did not have LIC503 Health Screening form with test for tuberculosis, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2022
Plan of Correction
1
2
3
4
Per Director, they will have Staff #3 & 8 get their LIC503 Health Screening with tuberculosis test completed with a physician and will provide copy to LPA by POC 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:Claudia Guangorena
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022


LIC809 (FAS) - (06/04)
Page: 6 of 6