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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019065
Report Date: 09/05/2024
Date Signed: 09/05/2024 04:35:15 PM

Document Has Been Signed on 09/05/2024 04:35 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:BLOOMING FLOWERS CHILD CARE CENTERFACILITY NUMBER:
198019065
ADMINISTRATOR/
DIRECTOR:		THOMAS, JAZMYNEFACILITY TYPE:
850
ADDRESS:680 E. ARROW HIGHWAYTELEPHONE:
(909) 399-0003
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 11DATE:
09/05/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Director Elaine DavisTIME VISIT/
INSPECTION COMPLETED:
05:00 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
On 9/5/2024 at 12:15pm, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced complaint investigation and during visit observed deficiencies. Upon arrival, LPA met with Director Elaine Davis and observed that she was in the classroom engaging with teaching staff and children. LPA observed 11 children and 4 teaching staff. Staff names were recorded.

During today's visit, LPA assisted Director with setting up age appropriate centers and to meet the needs of the different age groups. During today's visit, LPA reviewed staff files that were present. 2 teaching staff were observed to not have current mandated reporter training certificate.

During the investigation, LPA reviewed video recordings and observed deficiencies occur on recordings watched on 8/07/24. LPA observed teaching staff observe an incident/injury and did not report it to director or parent regarding the child getting injured. Teaching staff that was supervising the 2's and 3's was an aide and was alone in the nap room with children without a qualified teacher for over an hour.

Based on Licensing staff observations, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

Licensing staff informed licensee a copy of this licensing report dated 09/5/2024 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.

Page 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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 4
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: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065
VISIT DATE: 09/05/2024
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
A notice of site visit was given and must remain posted for 30 days as there are immediate risk(s) to the health, safety, or personal rights of children in care.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with Director Elaine Davis. Appeal Rights were issued and discussed.

Page 2 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/05/2024 04:35 PM - It Cannot Be Edited


Created By: Stephanie Li On 09/05/2024 at 03:43 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: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2024
Section Cited
CCR
101216.1(c)(1)(a)

1
2
3
4
5
6
7
To be a fully qualified teacher:
(1) Twelve semester or quarter units; and at least six months of work experience...units...child growth and development; child, family and community, or child and family; and program/curriculum.
This requirement was not met evidenced by:
1
2
3
4
5
6
7
Per Director, all age groups will conduct activities in the main room so that teacher with units can supervise aides working with children.
8
9
10
11
12
13
14
Based on observation and record review, one of one teacher supervising children does not have child development units to be alone with children, which poses a health and safety risk to children in care.
8
9
10
11
12
13
14
Type A
09/06/2024
Section Cited
CCR101212(d)(1)(B)

1
2
3
4
5
6
7
report shall be made to the Department...a written report shall be submitted to the Department within seven days following the occurrence of such event. (B) Any injury to any child that requires medical treatment.
This requirement was not met evidenced by:
1
2
3
4
5
6
7
Per director, will hold a staff training regarding reporting and documenting incidents, behaviors, and injuries. She will show CDSS training videos reviewing the topics and submit agenda and staff sign in sheet to LPA by 9/20/24.
8
9
10
11
12
13
14
Based on observation and video review, teaching staff did not notify director or parent of an injury a child sustained whil in care needing medical attention, which poses a health and safety risk to children in care.
8
9
10
11
12
13
14
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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/05/2024 04:35 PM - It Cannot Be Edited


Created By: Stephanie Li On 09/05/2024 at 03:55 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: BLOOMING FLOWERS CHILD CARE CENTER
FACILITY NUMBER: 198019065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
HSC
1596.8662

1
2
3
4
5
6
7
(b) (1)   On or before March 30, 2018, child care provider...employee of a licensed child day care facility shall complete the mandated reporter training ...shall complete renewal every two years...of the initial mandated reporter training.
This requirement is not met evidenced by:
1
2
3
4
5
6
7
Per Director, she will have the 2 teaching staff complete the mandated reporter training via the free online link provided from LPA and email the certificate to LPA by 9/20/24.
8
9
10
11
12
13
14
Based on observation, 2 teaching staff is missing the mandated reporter training certificate, which poses a health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Christina Gabelman
LICENSING EVALUATOR NAME:Stephanie Li
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4