STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY - DEPARTMENT OF SOCIAL SERVICES CDSS WILL LIGHTBOURNE DIRECTOR Community Care Licensing Orange County Child Care Regional Office 750 The City Drive South, Suite 250, Orange, CA 92868 www.ccld.ca.gov October 1, 2014 Gospel Pre-After School Facility number 304370350 Scan# 1 EDMUND G. BROWN JR. GOVERNOR ~TATE OF CAUFORNIA· HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT FACILITY NAME: GOSPEL PRE-AFTER SCHOOL ADMINISTRATOR: SUNG, JEAN ADDRESS: 13040 COAST PLACE CITY: GARDEN GROVE CAPACITY: 72 TYPE OF VISIT: POC MET WITH: Jean Sung - Director CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION CCLO Regional Office, 750 THE CITY DRIVE, SUITE Z50 ORANGE, CA 92888 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA CENSUS: 58 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 304370350 850 (714) 537-7949 92844 08/1212014 01:30PM 05:45PM NARRATIVE 1 This is a follow-up proof of correction visit that was made by LPA's Ho and Cong-Huyen. Upon 2 arrival, LPA's went to the school-age classroom (green room) and observed 1 aide alone 3 supervising 11 kindergartenlpreschool children and 9 school-age children. On the kindergartenlpreschool side in the Green Room, there were 10 children (1 school-age and 9 preschoolers) napping together. Director Jean Sung and staff# 2 were supposed to the Green 6 Room were both on their lunch break during the time of visit. The facility has been cited for leaving 7 s an aide to supervised all of the children by herself in the past as well as commingling between the 2 . -·9 ... age groups.-------. 10 11 LPA's toured the facility including the 3 preschool classrooms and observed 38 napping children 12 with 4 staff. A review of staff records on this date indica.tes all facility staff or other individuals who 13 required caregiver background checks have received criminal record and child abuse index 14 clearances or exemptions transfer request. 15 16 17 While LPA's were talking to director Jean Sung in the teacher break room by the kitchen, LPA 18 Cong-Huyen observed child #1 was walking back to his classroom without adult supervision. LPA 19 stopped the child and asked him where's he going. Director Sung jumped in stating he was going to 20 the bathroom and staff #1 was watching him. LPA Ho and Cong-Huyen observed staff #1 was in the 21 Hall room about 50 feels away and was unable to visually supervise child #1 while he was in the 22 bathroom. Facility was cited for Supervision issue on 712114 and 8111114 and again today 8112114. 23 An immediate $300 civil penalty is being assessed for repeating violation within 12 months. $50 civil 24 25 penalty per day will be assessed until deficiency corrected. i SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: (714) 703-2800 LICENSING EVALUATOR NAME: Thuy Ho TELEPHONE: (714) 703-2821 LICENSING EVALUATOR SIGNATURE: DATE: 08/1212014 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~~ DATE: 08/1212014 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC809 (FASJ ~ (06ro4) Page: 1 of 5 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT (Cont) FACILITY NAME: GOSPEL PRE-AFTER SCHOOL CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250 ORANGE. CA 92868 FACILITY NUMBER: 304370350 VISIT DATE: 08/12/2014 NARRATIVE 1 2 3 4 5 6 7 8 9 LPA reviewed the acknowledgement of receipt of licensing reports provided to director on 7/2114 filed in child's 2, 3, and 4' files and found 3 acknowledgement of receipt of licensing reports dated 7/15/14 & 7/16/14 have the same signatures. LPA Cong-Huyen asked director who signed the acknowledgement of receipt of licensing reports form and director stated she signed the acknowledgement of receipt of licensing reports forms because parents refused to sign it. According to the parents interviews conducted by LPA Ho, child #2,3,4were not enrolled at this facility since last day of June 2014. 10 11 12 13 14 15 After a tour of the center and review of children's records, the following deficiencies were observed and cited in accordance to California Code of Regulation Title 22. A Notice of Site Visit and the type A Evaluation Report Deficiency was posted today. Director was ··explalne~ DATE: 09/24/2010 t acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS). (06/04) Page: 1 of 2 Control Number 06-CC-20100917102939 STATE OF CALIFORNIA·HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE liCENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL FACILITY NUMBER: 304370350 VISIT DATE: 09/24/2010 NARRATIVE 1 2 3 4 5 6 An exit interview was completed. A copy of the Appeal Rights was given to the facility representative. All appeals must be in writing and received by the Licensing office within 10 days. If the facility had received a Type.A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility, and to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to kE)ep Acknowledgement Receipt (LIC 9224) signed by parents in each child's file. MyCCL Web Portal information was given to the facility representative. 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 THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR 30 CONSECUTIVE DAYS. FAILURE TO POST WILL RESULT IN CIVIL PENALTIES OF $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR. SUPERVISOR'S NAME: Dana Williamson TELEPHONE: (714) 703-2807 LICENSING EVALUATOR NAME: Judy Hanson TELEPHONE: (714) 703-2822 LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2010 LIC9099 (FAS)· (06/04) Pago: 2 of2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVlCES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVlCES COMMUNITY CARE UCENSING DIVISION FACILITY EVALUATION REPORT ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL ADMINISTRATOR: SUNG.• JEAN ADDRESS: 13040 COAST PLACE GARDEN GROVE CITY: 72 CAPACITY: TYPE OF VISIT: POC MET WITH: Ms. Sung 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 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA DATE: CENSUS: 31 UNANNOUNCED TIME BEGAN: TIME COMPLETED: 304370350 850 (714) 537-794~ 92844 09/10/2010 01:10PM 02:45PM NARRATIVE A follow up visit was conducted to review corrections from last visit. During visit Hundley and Hanson observed 5 staff caring for 26 preschool children with 3 teachers and 5 school age with 1 teacher in 4 separate classes. During visit LPAs observed a child walk around with no staff visually supervising her. Also observed was staff #2 leaving 8 napping children unattended in a classroom when she left the classroom with a child. LPAs discussed with director that staff are not visually supervising children at all times. When touring the rooms LPAs were unable to freely open a door due to a child sleeping in a cot and there was no walking space between the cots. LPAs discussed regulations with staff. Facility is in compliance with ratio and no commingling was observed, current staff are cleared except for Kathelyn Do who submitted clearances last week and clirectoris giving copies of TYPE A reports to parents.-On 09/07/10 [PA"discussed with direCtor that the swings needed to be mad inaccessible but on todays visit LPAs observed that the swings are still accessible with dishwashing mats. LPAs again discussed with director that she will need to submit corrections by due date and to make the swings inaccessible to children. LPA also reminded director that the LIC reports need to be posted where LPA posted them. The following deficiencies were cited on the next page. Upon receipt of Type A violations, the licensee shall post and provide copies of this facility report to parents/guardians of the children in care at the facility, and to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt signed by parents in each child's file. The licensee may use the LIC 9224 for parent's to sign as a receipt. SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 "''";!!;: '/'"} +f~uvJV--- DATE: 09/10/2010 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LICB09 (FAS) -(06104) Page: 1 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL FACILITY NUMBER: 304370350 VISIT DATE: 09/10/2010 NARRATIVE 1 2 3 An exit interview was completed. Appeal Rights and deficiencies were discussed. All appeals must be in writing and received by the Licensing office within 10 days. A copy of the Appeal Rights was given to the director. AB 633 fact sheet was given to, and discussed with, the facility representative this date. 4 5 Copies of LIC 995, LIC 9224 and PUB 393 were given to the facility representative. 6 7 8 9 THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR30 CONSECUTIVE DAYS. FAILURE TO POST WILL RESULT IN CIVIL PENALTIES OF $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: ~I Y-H-CMA~ DATE: 09/10/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2010 LIC809 (FAS) • (06/04) Page: 3 of 3 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) ORANGE CO C::HILD CARE, 750 THE CITY D_RIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 304370350 VISIT DATE: 09/10/2010 Deficiency Type POC Due Date I DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number Type A 09/08/2010 Section Cited 101229(a)(1) 1 2 3 4 5 6 7 1 Director agrees to discuss with staff ~nd parents RESPONSIBILITY FOR PROVIDING CARE & SUPERVISION: No child (ren) shall be left without 2 and send in verification of correction by due- date. 3 the supervision of a teach!;!r at any time. 4 Supervision shall include visual observation. At the time of visit, LPAs observed a-school-age child 5 wondering around by heiself and a teacher leaving 6 7 napping children unattended 8 in a classroom. Must be corrected immediately. 9 10 11 12 13 --14 Type A 09/10/2010 SectiOri CJied 1101239.1(d) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 - - - - NAPPING EQUIPMENT: Napping equipment shall 1 Director agrees to discuss with staff and parents 2 and send in verification of correction by due date. be arranged so that each child has access to a walkway Without having to walk-on or over the cots 3 or mats of other children. One cot Was blocking the 4 door and Other cots had no Walking Space between 5 6 them when being used by napping children. 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: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: ~~I Jlf~~ DATE: 09/10/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2010 This Notice must be posted for 30 days LIC809 {FASj- (06/04) Page: 2 of3 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09/15/2010 GOSPEL PRE-AFTER SCHOOL 304370350 13040 COAST PLACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 09/101201 o, have been cleared: Section Cited; 101229(a)(1) Plan of Correction: Director agrees to discuss with start and parenls and send in verification of cofreclion by due date. Date Due: 09/08/2010 Corrections: Correction received Sectiol] Cited: 1101239:1(d) Date Due: 09/10/201 o Plan of Correction: Corrections: Correction received. Director agreeS to discuss with staff and parents and send in verification of correction by due date. AME: Minerva Hundley Clearance Date: 09/10/2010 Clearance Date: 09/10/2010 TELEPHONE: (714} 703-2834 IGNATURE: DATE: 09/15/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter {FAS) • (04105) Page: 1 of 1 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL ADMINISTRATOR: SUNG, JEAN ADDRESS: 13040 COAST PLACE CITY: GARDEN GROVE CAPACITY: 72 TYPE OF VISIT; POC MET WITH: Ms. Sung 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 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA CENSUS: 37 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 304370350 850 (714) 537-7949 92844 09/07/2010 04:00PM 06:15PM NARRATIVE A follow up visit was conducted to review corrections from last visit. During visit LPA observed 3 staff caring for 26 preschool children in 3 separate classes. Eleven aft~r-school children were being cared for by one teacher in a classroom. During visit LPA observed 4 after-school children in the preschool area with 5 preschool children. Two teachers were caring for these children. Director informed LPA that she will request a waiver to commingle the programs for one hour in the morning and afternoon. During visit LPA was informed that staff files and childrem files are still incomplete. The forms were given to parents and staff to complete but they have not been returned !()the director. Director is requesting an extension to submit the forms. LPA inf9J"Q1ed director thatan.. eJS!ension will be granted untH nextwe_e~ 09/13/10 for.aiiJorm& El~cept for the children and staff physical and TB test will be extended until 09/30110.A deficiency is also being cited for lack of cushioning material under the swing set. Prior visit it was observed that a thin layer of carpet was placed under the swings. Today's visit it has been observed that mats with holes are being used this is not proper cushioning material to cushion a child's fall. Director agrees to removed the swings and will not allow the children to use the swings until proper cushioning material is installed. During visit LPA observed that a new staff person is working at the facility and no clearances are associated or cleared for Ms. Kathelyn Do who supervises the school age children. Director showed LPA a Livescan form which was done today. LPA explained that she needs to wait to receive the persons clearances before the person is allowed to work with day care children. A civil penalty is being cited for today. Ms. Do cannot work with the day care children until her clearances are cleared. LPA discussed fingerprint clearances with director today and prior visit. The facility was not in compliance and violation(s) of the Califoniia Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. Upon receipt of Type A violations, the licensee shall post and provide copies of this facility report to parents/guardians of the children in care a( the facility, and to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt signed by parents in each child's file. The licensee may use the LIC 9224 for parent's to sign as a receipt. This report is to be on file and accessible for public review at the facility for at least 3 years. SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2010 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. L1C809(FAS)- (06/04) Page: 1 of 4 STATE OF CAUFORNJA • HEALTli AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO'CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 304370350 VISIT DATE: 09/07/2010 Deficiency Type POC Due Date/ PLAN OF CORRECTIONS(POCs) DEFICIENCIES Section-Number Type A 09/07/2010 Section Cited 101170(6) -·--- Type A 09/30/2010 Section Cited 101238:2(e)(1) Type A 09/07/2010 Section Cited 101538.3 1 2 3 4 5 6 7 CRIMINAL RECORD CLEARANCE: All individuals 1 Director is to submit a written letter on how she will 2 comply with fingerprint regulations when hiring 3 staff. 4 5 6 7 subject to a criminal record review Shall prior to working in a licensed facility\ obtain a california clearance or~ criminal record exemption or reques a transfer of a criminal record clearance. 8 9 10 11 12 13 14 8 9 10 Kathlelyn Do. She started to work today. A civil penalty is issued for $100.00. Ms. Do cannot be at 11 th~_ facilit~ until fingerprint clearances a~e ~!eared._ 12 13 14 1 2 3 4 5 6 7 Outdoor Activity Space: play are-as require cushioning. Swings has carpet and mats with holes which is not proper cushioning material. This can place children in an unsafe situation. 1 2 3 4 5 6 7 INDOOR ACTIVITY SPACE FOR 101538.3 SCHOOL-AGE CHILDREN: No commingling Fingerprints were submitted through Uvescan today but no clearan-ces have been obtained for Program separation must be maintained. School age children were being cared in the preschool area with preschool children. 1 Director agrees to not allow children to use the 2 swings and to send a plan on how she will take 3 care of the situation to CCL by due date. 4 5 6 7 1 2 3 4 5 6 7 Director agrees to _comply With regulations and request for a to commingle only for one hour in the moring and afternoon. She also agrees to keep the children separate in their own program space. Director agrees to submit a written plan of correction. 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: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2010 This Notice must be posted for 30 days UC809jFAS) • (06104) Page: 2 of4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING'DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHILO CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL FACILITY NUMBER: 304370350 VISIT DATE: 09/07/2010 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 1.4 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 An exit interview was completed. Appeal Rights and deficiencies were discussed. All appeals must be in writing and received by the Licensing office within 10 days. A copy of the Appeal Rights was given to the director. AB 633 fact sheet was given to, and discussed with, the facility representative this date. THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR 30 CONSECUTIVE DAYS. FAILURE TO POST WILL RESULT IN CIVIL PENALTIES OF $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR. Please submit the following to update your files: LIC501. Employment application LIC308 Designation of Administrative authority LIC503 Health Screening and TB Test for Ms. Sung Copy_pftraJlst;ripts for Ms, S~ng 15 hours ofCPR/First aid and Health Safety for Ms. Sung Ms. Sung attend Component 3 LIC626 Emergency Disaster plan LICSOO Personnel report LIC215 Application LIC508 Criminal Record Statement. UC401, UC420,LIC403 and LIC404 Budget and Financial information. LIC999 Facility sketch Disaster and Fire drills Plan of operation Admission policies and procedures/Fee schedule SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2010 LIC809 (FAS) • (06104) Page: 3 of 4 STATE OF CAUFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT {Cont) ORANGE CO CHILO CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number TypeS 09/10/2010 Section Cited H&S1596.8595b1 Type 8 09/07/2010 Section Cited H&S1596.8595c1 FACILITY NUMBER: 304370350 VISIT DATE: 09/07/2010 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 H&S1596.8595b1 Failure to post written TYPE A 2 reports at the facility for parent to review. 3 H&S1596.8595c1 Failure to submit Type A written 4 reports to parents and failure to obtain written 5 receipt. 6 7 1 Director agrees to submit copies of signed forms to 2 CCL. 3 4 5 6 7 1 H&S1596.8595.c1 Failure to submit Type A written 2 reports to p'arents and failure to obtain written 3 receipt. 4 5 - - - - --- 6 7 1 Director posted during visit. 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 4 5 6 7 1 2 1 2 3 3 4 5 6 7 4 5 6 7 ~ 3 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: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: ;M~ DATE: 09/07/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2010 LJC809 (FAS) • (06/04) Page: 4 of 4 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09/10/2010 GOSPEL PRE-AFTER SCHOOL 304370350 13040 COAST PLACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 09/07/2010, have been cleared: Section Cited: 101170(6) Plan of Correction: Director I~ to submit a Wiitten letter on how she will comply wlth fingerprint regulations when hiring staff. Date Due: 09/07/2010 Corrections: Cleared By Visit Clearance Date: 09/.10/2010 Section Cited: 101538.3 Plan of Correction: Directocag'rees to comply with regulations and request for a to commingl_e only for one hour in the morlng and afternoon. She illso agrees to keep the children separate in their own program space. Director agrees to submit a written plan of correction. Date Due: 09/07/2010 Corrections: Cleared By Visit Clearance Date: 09/10/2010 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: VV\~ DATE: 09/10/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS). (04/05) Page: 1 of 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVJCES COMMUNITY CARE UCENSING DMSION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09/10/2010 GOSPEL PRE-AFTER SCHOOL 304370350 13040 COAST PLACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 09/07/2010, have been cleared: Section Cited: H&S1596.8595b1 Plan of Correction: Director agrees to submit copies of signed forms to CCL. Section Cited: H&S1596.8595c1 Plan of Correction: Director posted during visit. Date Due: 09/10/2010 Corrections: Cleared By Visit Clearance Date: 09/10/2010 Date Due: 09/07/2010 Corrections: Cleared By Visit Clearance Date: 09/10/2010 TELEPHONE: (714) 703-2834 DATE: 09/10/2010 This report must be available at Child Care and Cleared POC Letter (FAS) - {04/05) roup Home facilities for public review for 3 years. Page: 1 ~f 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAliFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL ADMINISTRATOR: SUNG, JEAN ADDRESS: 13040 COAST PLACE CITY: GARDEN GROVE CAPACITY: 72 TYPE OF VISIT: Annual/Random MET WITH: Ms. Sung 1 2 3 4 5 6 7 --8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA DATE: CENSUS:43 UNANNOUNCED TIME BEGAN: TIME COMPLETED: 304370350 850 (714) 537-7949 92844 08/30/2010 04:00PM 07:45PM NARRATIVE purpo$e of this visit was to conduct an Annual Evaluation of the facility. LPA M. Hundley toured the facility inside and outside. Census was taken in individual classrooms. The overall census observed was 2 preschool staff caring for 16 preschool children in the play yard, 1 preschool teacher caring for 11 preschool children in a classroom and 1 school age teacher caring for 16 children in a classroom. Another staff was observed in the kitchen cleaning. During visit teacher's were not aware who was in charge. They informed LPA that the director left and no one was in charge. Director arrived about 20 minutes after LPA arrived. Director informed LPA that the 5 of the school age children are in kindergarten and they are 6 years old. These children are being commingled in'the school age program: LPNdiscussed with directorthatthe facility was given a waiver for only 12 school age children and she cannot commingle any other children with these children which need a separate classroom. Her license is for preschool children ages 2-6 years old, and a waiver for 12 school age children. LPA also discussed with director that she has a staff, Ms. Silvia Jimenez, who is caring for children and her clearances are not associated to the facility. Ms. Jimenez informed LPA that she is a substitute teacher for today. A $1 OO.OOCP will be assessed for today. Director faxed the association form for Ms. Jimenez to CCL today. Facility is violating the terms and conditions of the license, ratio, clearances and other deficiencies . The following was inspected during visit: Medication, food storage, sign in/out, 1" aid/CPR, cleaning supplies storage, napping equipment, and drinking water were inspected. Facility met all posting requirement. Teacher files and children files were reviewed. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions, except Ms. Jimenez. The facility was not in compliance and violation(s) of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. Th~ 23 24 25 SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2010 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2010 This report .must be available at Child Care and Group Home facilities for public review for 3 years. UC809 (FAS) • (06/04) Page: 1 of 6 STATE OF CAUFORNIA • HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY ORNE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number FACILITY NUMBER: 304370350 VISIT DATE: 08/30/2010 PLAN OF CORRECTIONS(POCs) DEFICIENCIES TypeB 09/03/2010 Section Cited 101216(g) 1 2 3 4 5 6 7 PERSONNEL REQUIREMENTS: All personnel, including the licensee, administrator and volunteers, shall be in good health and shall be physically and mentally capable of performing assigned tasks .... physical health shall be. verified by a health screening, including a test for tuberculosis. Lacking for staff See LIC859. 1 The director will submit copy(ies) of the Health 2 scree'ning and TB test to CCL. 3 4 5 6 7 Type B 09/03/2010 SectiOn Cited 101217(a) 1 2 3 4 5 6 7 PERSONNEL RECORDS: The licensee shall enSure that persohnel records '* are maintained on the licensee, administrator and each employee'* . Application is missing from staff files. see UC859. 1 Ttle director agrees to submit a copy(ies) of the 2 personnel record application for the emp!oyee(S) to 3 CCL. 4 ·5 . 6 7 09/03/2010 Section Cited 1 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: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2010 1 acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2010 LIC809 (FAS) • (DG/04) Page: 2 of6 STATE OF CALIFORNIA- HEAlTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92866 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL FACILITY NUMBER: 304370350 VISIT DATE: 08/30/2010 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Upon receipt of Type A violations, the licensee shall post and provide copies of this facility reportto parents/guardians of the children in care at the facility, and to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt signed by parents in each child's file. The licensee may use the LIC 9224 for parent's to sign as a receipt This report is to be on file and accessible for public review at the facility for at least 3 years. An exit interview was completed. Appeal Rights and deficiencies were discussed. All appeals must be in writing and received by the Licensing office within 10 days. A copy of the Appeal Rights was given to the director. AB 633 fact sheet was given to, and discussed with, the facility representative this date. THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR 30 CONSECUTIVE DAYS. FAILURE TO POST WILL RESULT IN CIVIL PENALTIES OF $100.00. _THE 'NOTICE_OF_SITE\/ISI}:' Vv'A~ POSTEll ONTHE DOOR. Please submit all Corrections or updates to assigned analyst: Minerva Hundley Community Care Licensing 750 The City Dr. Suite #250 Orange Ca. 92868 Direct number 714 703-2834, Office# {714) 703-2800, Fax: {714) 703-2831 Email: Minerva.Hundley@dss.ca.gov 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Marian Wallmeier TELEPHONE: {714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: fJJ\/)~ DATE: 08/30/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2010 LIC809(FAS) - (06/04) Paga: 3 of 6 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL FACILITY NUMBER: 304370350 VISIT DATE: 08/30/2010 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency TYpe POC Due Date I DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number Type B 09/03/2010 Section Cited 101221(b)(6) Type B 09/03/2010 SectiOn Cited 101221(b)(8) Type B 09/03/2010 Section Cited 101221 (b)(8)(C) Type B 09/03/2010 Section Cited 10121ff.1(b)(1) 1 CHILD'S RECORDS: A signed copy of the 1 Licensee agrees to send copy of completed form 2 admission agreement specified in Section 101219. 2 for the children records reviewed this date to 3 licerlsing and give out this for to all parents who 3 See LIC 857 Children files lacking forms. 4 have children enrolled at the center. 4 5 5 6 6 7 7 1 CHILD'S RECORDS: Medical assessment, 2 including ambulatory status. as specified in Section 3 101220. See LIC 857 Children files lacking forms. 4 5 6 7 1 2 3 4 5 6 7 1 CHILD'S RECORDS: A signed consent form for 2 emergency medical treatment unless the child's 3 authorized representative has signed the 4 statement. See LIC 857 Children files lacking 5 forms. 6 7 1 2 3 4 5 6 7 Licensee agrees to send copy of completed form for the children records reviewed this date to licensing and give out this for to all parents who have children enrolled at the center. 1 2 3 Notification of Parents' rights. LIC 995: Parent's rights receipts were not found in enrollinent packet. 4 5 See LIC 857 Children files lacktng forms. 6 7 Licensee agrees to send copy of completed form fOr the children records reviewed this date to licensing and give out this for to _all parents who have children enrolled at the center. 1 2 3 4 5 6 7 ADMISSION PROCEDURES: The Center shall give each authorized-representatfVe- a coPY cifthe Licensee agrees to send copy of completed form for the children records revieWed this date to licensing and give out this for to all parents who have children enrolled at the center. - "-- - 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: Marian Wallmeier TELEPHONE: (714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: {Vl(/~ DATE: 08/30/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2010 LIC809 (FAS) • (06/04) Page: 4 of 6 STATE OF CAUFORNIA ·HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 304370350 VISIT DATE: 08/30/2010 Deficiency Type POC Due Date I DEFICIENCIES PLAN OF CORRECTIONS{POCs) Section Number TypeS 09/03/2010 Section Cited 101223(A)(b)(1) TypeS 09/03/2010 Section Cited .. 101220(a)(1) TypeS 09/03/2010 Section Cited 101220(b )(2) TypeS 09/03/2010 Section Cited 101220.(1)(h)1 1 2 3 4 5 6 7 Rights form LIC 613A. See LIC857 Children files lacking forms. 1 2 3 4 5 6 7 within 30 ccilendar days after enrollment of a child, the licensee shall obtain a medical assessment. Children files lacking forms. -· -· -- ----- ---- - 1 2 3 4 5 6 7 1 2 3 4 5 6 7 PERSONAL RIGHTS: The center shall give each authorized representative a copy of the P~rsonal CHILD'S MEDICAL ASSESSMENTS: Prtor to, or The medical assessment shall provide the results of a TB test or the TB rtsk factor. Children files lacking forms. Refer to the LIC857. IMMUNIZATION: The California Code of RegulatiOns, Title 17, Section 6075, 'specifies in pertinent part that each child care ,center shalt report to state and local health departments. Refer to the LIC 857 Children files lacking forms. 1 2 3 4 5 6 7 Director agrees to send copy of completed form for the children records reviewed this date to licensing and give out this for to all parents who have children enrolled at the center 1 Director agrees to submit a copy to CCL. 2 3 4 . 5 6 7 -· 1 Director agrees to submit a copy to CCL. 2 3 4 5 6 7 1 2 3 4 5 6 7 The director will obtain the Blue Cards form the Health Department and complete the form for each child enrolled. Submit to Licensing verification copies of the missing 'forms. 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: Marian Wallmeier TELEPHONE: {714) 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: {714) 703-2834 LICENSING EVALUATOR SIGNATURE: NV~ DATE: 08/30/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2010 !.IC809 {FAS) • {06/04) Page: 5 of 6 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAl SERVICES COMMUNITY CARE liCENSING DIVISION FACILITY EVALUATION REPORT (Cont) ORANGE CO CHilD CARE, 750 THE CITY ORNE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 304370350 VISIT DATE: 08/30/2010 Deficiency Type POC Due Date/ DEFICIENCIES PLAN OF CORRECTIONS(POCs} 101161 LIMITATIONSONCAPACITY AND AMBULATORY STATUS (a) A licensee shall not operate a child care center beyond the 1 Director agrees to only allow 12 school age 2 children as the waiver permits. She will comply by 12 school age children only. 7 Section Number Type A 08/30/2010 Section Cited 101161a 1 2 3 4 5 6 7 3 today and send a written correction by tomorrow. conditions and limitations specified on the license, 4 5 including the capacity limitation. Facility is not meeting the school age waiver, which is to care for 6 8 9 10 11 - - 12 13 14 8 LPA observed one teacher caring for 16 children, 9 ages 6:-12 by herself in a classroom. 10 11 12 13 14 Type A 08/30/2010 SeCtion Cited 101216.3a Type A 08/30/2010 Section Cited 101170f 1 2 3 4 5 6 7 There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. A teacher was caring for 16 children ages 6-12 in a classroom by herself. Director informed LPA that five children belonged tO the preschool program. 101216.3 TEACHER-CHILD RATIO(a) 1 2 3 4 CRIMINAL RECORD CLEARANCE: An individual 1 Director faxed in the fonm for Licensing to associate 2 staff to the facility. 3 4 may request a transfer-of their criminal record clearance from one state licensed facility to another. Staff w8s not associated to the faCility. 5 Staff person was supervising ·11 children by herself. 1 2 3 4 5 6 7 Director agrees to correct not allow the preschool program to eommingle with the school age children. She will comply by today and send a written correction by tomorrow. 5 6 MUST BE CORRECTED IMMEDIATELY. $100 Cp 6 7 assessed. 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: Marian Wallmeier TELEPHONE: (714} 703-2808 LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: {714} 703-2834 LICENSING EVALUATOR SIGNATURE: ( DATE: 08/30/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~~ DATE: 08/30/2010 This Notice must be posted for 30 days UC809 (FAS) -(06/04) Page: 6 of6 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT" IMMEDIATE ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME DATE GOSPEL PRE-AFTER SCHOOL 08/30/2010 FACILITY ADD~ESS CITY 13040 COAST PLACE GARDEN GROVE STATE ZIP CODE CA 92844 LICENSEE(S)/OPERATOR FACILITY NUMBER SUNG, JEAN 304370350 Immediate civil penalties can be-_assessed against any licensee for failure to comply with criminal background check requirements and against family child care licensees for failure to comply with parentiguardian notification and visit report posting requirements.See the back of this form for specifics. On-this date;you have been found in violation of one or more requirements for which an immediate civil penalty is-warranted. See the Facility Evaluation Report (LIC 809} issued on this date. You are hereby notified that a civil penalty has been assessed. 0 $100 immediate_ Civil Penalty per person for allowing any person (who is subject to a background check) to work, reside or x volunteer without a criminal record clearance or exemption. Maximum 5 days for first violation. 0 $100 immediate Civil Penatty per person for allowing any person (who is subject to a background check) to work, reside or x_ volunteerwi_!h~ut a c~imi~al!.~.cord clearance or ~xel'!_'lption.__!:Aaxi~_um of 30 days for subs~~u_ent vio_lations. !61 $100 immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before x requesting a clearance transfer or before receiving approval of an exemption transfer. ' 0 $100 immediate Civil Penalty per parenUauthorized representative for failure to provide "Family Child Care Home Addendum tp x Notification of Parents' Rights (Regarding Exclusion)". 0- $100 immediate Civil Penalty per parenUauthorized representative for failure to provide "Family Child Care Home Addendum to x Notification of Parents' Rights (Regarding Reinstatement)". 0 0 0 x $100 immediate Civil Penalty per parenUauthorized representatiVe for failure to obtain signature indicating receipt of Addfmdum. x $100 immediate Civil Penalty for failure to provide signed addendum to the Department when requested. x $100 immediate Civil Penalty for failure to post the "Notice of Site Visit Report" for 30 consecutive days. number of days X $100 = Individual #2 number of days X $100 = Individual #3 number of days X $100 Individual #1 Silivia Jimenez = Total $100.00 Penalty $0.00 Penalty $0.00 Penalty $100.00 YOU WILL RECEIVE A BILL IN THE MAIL DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Minerva Hundley SIGNATURE OFLICENSING PROGRAM ANALYST NAME OF FACILITY REPRESENTATIVEfTITLE Jeanne Sung SIGNATURE OF FACILITY REPRESENTATIVE SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 08130/2010 TITLE LIC421 B (FAS)- (OS/06) Page: 1 of2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES,AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09/10/2010 GOSPEL PRE-AFTER SCHOOL 304370350 13040 COAST PJ.ACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 08/30/2010, have been cleared: Section Cited: 101161a Plan of Correction: Director agrees to only allow 12 school age children as the waiver pennits. She Will comply by today and send a written correction by tomorrow. Section Cited: 101216.3a Plan of Correction: Director agrees to collect not allow the preschoOl program to commingle with the school age children. She will comply by today and send writleri correction by' tomorrow. Date Due: 08/30/2010 Corrections: Cleared By Visit Clearance Date: 09/10/2010 Date Due: 08/30/2010 Corrections: Cleared By Visit Clearance Date: 09/10/2010 Date Due: 08/30/2010 Corrections: Cleared By Visit Clearance Date: 09/10/2010 a Section Cited: 1011701 Plan of Correction: Director faxed in the fonn for Licensing to associate staff to the facility. LICENSING EVALUATOR NAME: Minerva Hundley TELEPHONE: (714) 703-2834 LICENSING EVALUATOR SIGNATURE: t\A~ DATE: 09/10/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 STATE OF CAUFORNIA ~HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09115/2010 GOSPEL PRE-AFTER SCHOOL 304370350 13040 COAST PLACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 08130/2010, have been cleared: Section Cited: 101223(A)(b)(1) Plan of Correction: Director agrees:to send copy of completed form for the children records reviewed this date to licensing and give out this for to all parents who haVe children enrolled at the center Date Due: 09/03/2010 Corrections: Correction received. Section Cited: 101220(a)(1) Plan of Correction: Date Due: 09/03/2010 Corrections: Director agrees to submit a copy to CCL. Correction received. Section Cited: 101220(b)(2) Plan of Correction: Date Due: 09/03/2010 Corrections: Director agrees to submit a copy to CCL. Correction received. Section Cited: 101220.(1)(h)1 Plan of Correction: Date Due: 09/03/2010 Corrections: The director will obtain the Blue Cards form the Health Department and complete the form for each child enrolled. Submit to Licensing verification copies of the missing forms. Correction received. LICENSING EVALU Clearance Date: 09/13/2010 Clearance Date: 09/13/2010 Clearance Date: 09/13/2010 Clearance Date: 09/13/2010 TELEPHONE: (714) 703-2834 DATE: 09/15/2010 This report st be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC letter (FAS)- (04/05) P.age: 1 of 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09/15/2010 GOSPEL PRE-AFTER SCHOOL 304370350 13040 COAST PLACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 08/30/2010, have been cleared: Section Cited: 101221(b)(6) Date Due: 09/03/2010 Plan of Correction: Corrections: Correction received. Licensee agrees to send copy of completed forin for the children records reviewed this date to licensing and give out this for to all parents whO have children enrolled at the center. Section Cited: 101221(b)(8) Date Due: 09103/2010 Plan of Correction: Corrections: Correction received. Licensee agrees to send copy of completed form for the children records reviewed this date to licensing and give out this for to all parents wtio have children enrolled at the center. Section Cited: 101221(b)(8)(C) Date Due: 0910312010 Plan of Correction: Licensee agrees to serid copy of completed form for the children Corrections: Correction received. Clearance Date: 0911312010 Clearance Date: 09/1312010 Clearance Date: 0911312010 records reviewed thjs dale to licensing and give out this for to all parents who have children enrolled at the center. Section Cited: 101218.1(b)(1) Date Due: 0910312010 Plan of Correction: Corrections: Correction received. Licensee agrees tO send copy of completed form ror the children records_reviewed this date to licensihg and give out this for to all parents who have children enrolled at the center. NAME: Minerva Hundley Clearance Date: 0911312010 TELEPHONE: {714) 703-2834 SIGNATURE: DATE: 09/15/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter {FAS) • {04/05) Page: 1 of 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE CO CHILD CARE 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 09/15/2010 GOSPEL PRE'AFTER SCHOOL 304370350 13040 COAST PLACE GARDEN GROVE, CA 92844 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 08/30/2010, have been cleared: Section Cited: 101216(g) Plan of Correction: The director will submit copy(ies) oi the Health screening and TB test Date Due: 09/03/2010 Corrections: Correction received. Clearance Date: 0911312010 Section Cited: 101217 (a) Plan of Correction: The director agrees to submit a copy{ies) of the personnel record application for the emptoyee(s) to CCL. Date Due: 0910312010 Corrections: Correction received. Clearance Date: 0911312010 Section Cited: 1 Plan of Correction: Date Due: 09103/2010 Corrections: Correction received. Clearance Date: 0911312010 to CCL. R NAME: Minerva Hundley TELEPHONE: (714) 703-2834 R SIGNATURE: DATE: 09/15/2010 This rep must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT ORANGE CO CHILD cARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 This is an official report of an un;mnounced visiUinvestigation of a complaint received in our office on 07/29/2009 and conducted by Evaluator Susan Du COMPLAINT CONTROL NUMBER: 06-CC-20090729102052 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL ADMINISTRATOR: SUNG, JEAN ADDRESS: 13040 COAST PLACE CITY: GARDEN GROVE CAPACITY: 72 Jean Sung MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE: DATE: CENSUS: 35 UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 304370350 850 (714) 537-7949 92844 08/03/2009 08:00AM 12:15 PM ALLEGATION(S): 1 LACK OF SUPERVISION: school age children are unsupervised in the morning until school age staff arrives 2 3 PERSONAL RIGHTS: paper towels not available and children shared cloth towels 4 5 6 7 PHYSICAL PLANTS: restrooms do not have paper towels available for children to use FOOD SERVICE: styrofoam plates were reused 8 9 INVESTIGATION FINDINGS: 1 Licensing Program Analyst (LPA) Du conducted a complaint investigation on this date. LPA met with director, 2 Jean Sung. Census was taken at time of arrival. There were a total of 9 preschool children in the multipurpose 3 room with director, Jean Sung and 3 school age children in the school age room (green room) unsupervised by 4 any staff member. Director left the big room and walked. over to the school age classroom and told the school 5 age children to stay in the big room. Census was taken again about 1 hour later. There were a total 9f 29 6 preschool children with 3 staff observed and 7 school age children with 1 staff observed. LPA observed Blue 7 Classroom had 13 children with 1 staff. A review of staff records on this date indicates that all facility staff or 8 other individuals who required caregiver background checks have received criminal record and child abuse 9 index clearances or exemptions. 10 LPA interviewed staff, children, and director. Director stated the school age children are the their classroom 11 because they wanted to read books. She said they are usually in the room next door so she could watch them. 12 LPA observed that there were 13 children with 1 staff in the Blue Classroom. 13 Estimated Days of Completion: Substantiated SUPERVISOR'S NAME: Dana Williamson TELEPHONE: (714) 703-2807 LICENSING EVALUATOR NAME: Susan Du TELEPHONE: (714) 703-2816 LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: r~~ DATE: 08/03/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of 4 Control Number 06-CC-20090729102052 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAl,. SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NUMBER: 304370350 VISIT DATE: 08/03/2009 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL NARRATIVE 1 2 3 4 5 6 7 8 9 10 1.1 12 13 14 15 16 17 18 19 .20 21 22 23 24 25 26 27 28 29 30 31 32 Director denied that children are sharing the cloth towels. Director stated paper towels are available for children to use in the classroom. Director stated teachers bring in the paper towels from the classroom into the restroom each time. Staff interviewed stated the children had been using the cloth towels until a few months ago. Children interViewed admitted thatthere are no paper towels available in the restroom. Children stated they had used the cloth towels before. Director admitted that styrofoam plates were reused before when a few cracker crumbs were left on the styrofoam plates. Staff interviewed said that there had been a few times that the styrofoam plates were reused, but not recently. Based on the information gathered, the above allegations are found to be substantiated at this time. The facility was not in substantial compliance and in violation of the California Code of Regulations, Title 22, Division 12were observed, discussed and cited at the time of the visit. (See LIC 809-D for specific deficiency(ies), Type "A" violations and report must be posted next to Notice of Site visit Poster. Upon receipt, licensee shall post and provide.copies ofJhis report to parents/Guardians of children in care and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee is to keep acknowledgement receipt signed by parents in each child's file. Licensee may use Lie. 9224 for this purpose. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal Rights explained. All appeals must be in writing and received by the licensing office within 10 days. This report is to be on file and accessible for public review at the facility for at least 3 years. Exit interview was conducted. SUPERVISOR'S NAME: Dana Williamson TELEPHONE: (714) 703-2807 LICENSING EVALUATOR NAME: Susan Du TELEPHONE: (714) 703-2816 LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2009 . I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2009 LIC9099 (FAS)· (06104) Page: 2 of 4 Control Number 06-CC-20090729102052 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 304370350 VISIT DATE: 0810312009 Deficiency Type POC Due Date I DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number Type A 08/10/2009 Section Cited 101227 1 2 3 4 5 6 7 FOOD SERVICE: all dishes and utensils used for 1 Director agrees to not reusing styrofoam plates. eating and drinking, and in the preparation of food 2 and drink, shall be cleaned and sanitized after each 3 Director agrees to have a meeting with staff to 4 review Food Service section 'and submit a written use. 5 plan to ensure compliance. 6 Director admitted that reusing styrofoam plates. 7 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 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: Dana Williamson TELEPHONE: (714) 703-2807 LICENSING EVALUATOR NAME: Susan Du TELEPHONE: (714) 703-2816 LICENSING EVALUATOR SIGNATURE: DATE: 0810312009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 0810312009 This Notice must be posted for 30 days LIC9099 (FAS)· (06104) Page: 3 of 4 Control Number 06-CC-20090729102052 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250 ORANGE, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number -- FACILITY NUMBER: 304370350 VISIT DATE: 08/03/2009 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 MUST BE CORRECTED IMMEDIATELY. Type A 08/03/2009 Section Cited 101229 1 PROVIDING CARE & SUPERVISION: No child 2 {ren) shall be left without the supervision of a 3 teacher a't any time. Supervision shall include 4 visual observation. 5 At the time of visit, LPA observed 3 school age 6 children in the school age classi'oom by 7 themselves. 2 3 4 5 6 7 1 2 3 4 5 6 7 TEACHER-CHILD ·RATIO: There shall be a ratio o one teacher visually observing and supervising no more than 12 children in attendance During visit, LPAobserved a~teacher with 13 children in the bh.1e classroom. Director moved one child to yellow ClassroOm. 1 2 3 4 5 6 7 MUST BE CORRECTED IMMEDIATELY. Type A 0810312009 Section Cited 101216.3 Type A 08/10/2009 SeCtion Cited 101223 1 2 '3 4 5 6 7 PERSONAL RIGHTS: The licensee shall ensure that each child is accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. Paper towels not available in the restroom and children had to Use cloth towels or shake dry their hands or wipe on their clothes. 1 2 3 4 5 6 7 Director agrees to provide_ paper towels in the restroom at all times for children and staff. DireCtor will submit a written plan to licensing about how to ensure that paper towels are readilY available for children to use in the restroom by due date~8/1 0/09 Type A 08/10/2009 Section Cited 101239 (j) 1 2 3 4 5 6 7 IXTURES, FURNITURE, EQUIPMENT AND SUPPLIES: Common towels or washcloths are prohibited. LPA observed cloth lowels in the preschool restroom. Staff interviewed stated previously children had been using a towels. This could place children in an unsafe environment. 1 2 3 4 5 6 7 Director agrees to~provide paper towels in the~ restrooins at all times for children and staff to use. Director agrees to remove all the cloth towels. Director agrees to have a staff meeting and discuss this regulation with staff and ensure compliance at all times. Director moved the 3_ school a:ge children into the multipurpose room. Director stated will have the school age children remain the multipurpose rOom until the School age teacher arrives. Dorector will submit to licensing a written plan by due date 8/10/09. Director stated will ~ither hire an assistant or arrange the classroom ratio to ensure compliance to teacher ~child- ratio. Director agrees to submit a written plan to licensing office by due date 8/10/09. 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: Dana Williamson TELEPHONE: (714) 703-2807 LICENSING EVALUATOR NAME: Susan Du TELEPHONE: (714) 703-2816 LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2009 This Notice must be posted for 30 days LIC9099 {FAS) • (06/04) Page: 4 of 4 STATE OF CAUFORNtA- HEALTH AND HUMAN SE.RV1CES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENS!NG DMSION FACILITY EVALUATION REPORT Orange Co. ChlldCare, 760 Tho Clty Drive, Suite 250 Orange, CA 9.2.868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL ADMINISTRATOR: SUNG, JEAN ADDRESS: 13040 COAST PLACE CITY: GARDEN GROVE CAPACITY: 72 TYPE OF VISIT: AnnuaVRandom Jean Sung MET WITH: STATE:CA CENSUS: 36 UNANNOUNCED FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 304370350 850 (714) 537-7949 92844 12/05/2008 12:00 PM 03:00PM NARRATIVE 1 T~e purpose of this visit was to conduct an Annual/Random Evaluation ofthe facility. LPA toured the facility 2 inside and outside. Met with director Sung • Census was taken in individual classrooms. The overall census observed was 6 preschool staff and 36 preschool children, no school-age children observed. Medication, food storage, sign infout, 1" aidfCPR, cleaning supplies storage, napping equipment, and drinking water were inspected. Facility met all posting requirement. Teacher files were reviewed and Evaluation of Teacher Qualifications were completed. Children's files were reviewed. A review of staff records on this date indicates thataUfacilily staff or other individualswho require caregiverbackground checks have received criminal record and child abuse index clearances or exemptions. 3 4 5 6 7 -8- 9 10 11 12 13 14 15 16 17 18 19 20 21 The facility was notin compliance and violation(s) of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. Upon receipt ofType A violations, the licensee shall post and provide copies of this report to parentsfguardlans of the children in care at the facility, and to the parentsfguardians of children newly enrolled at the facility during the next 12 months. The licensee is to keap Acknowledgement Receipt signed by parents in each child's file. The licensee may use LIC 9224 for Upon receipt of Type A violations, the licensee shall post and provide copies of this report to parentsfguardians of the children in care, and to the parentsfguardians of children newly enrolled at the facility during the next 12 months. The licensee is to J5.eep Acknowledgement Receipt signed by parents in each child's file. The licensee may use LIC 9224 for this purpose. (see 809C, D) 22 23 24 25 SUPERVISOR'S NAME: Dana Williamson TELEPHONE: (714) 703-2800 LICENSING EVALUATOR NAME: Yollanda Leon TELEPHONE: (714)703-2800 LICENSING EVALUATOR SIGNATURE: • ~, ,.. ~~e..---- DATE: 12/0512008 I acknowledge receipt of this fonm and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: . ,letfN ./•r- DATE: 1210512008 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC009 (FAS)- (00104) Page: 1 of4 STATEOFCALIFORNIA HEALTH AND HUMAN SERVICES AGENCY - FACILITY EVALUATION REPORT (Cont) CALIFORNIA DEPARTMENT OF soctAL SERVICES COMMUNITV CARE UCENSING OMSlON Orange Co. ChlldCato, 760 The CUy Drive, 5ufte 250 Orange, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL FACILITY NUMBER: 304370350 VISIT DATE: 12105/2008 NARRATIVE 1 2 3 4 5 6 7 8 9 10 An exit interview was completed. Appeal Rights and deficiencies were discussed. All appeals must be in writing and received by the Licensing office within 10 days. A copy ofthe Appeal Rights was given to the director. AB 633 fact sheet was given to, and discussed with, the facility representative this date. Copies of LIC 995, LIC 9224 and PUB 393 were given to the facility representative. THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR 30 CONSECUTIVE DAYS. FAILURE TO POST WILL RESULT IN CIVIL PENALTIES OF $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR. Documents/Information to be updated and returned to the Licensing Office; - Personnel Report (LIC 500) - Emergency Disaster Plan (LIC 610) 13 - Designation of Administrative Responsibility (LIC 308) 14 · - Administrative Organization (UC 309) 15 • Fire Drill Log 16 • written plan of correction . 17 11 12 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Dana Williamson TELEPHONE: (714) 703-2800 LICENSING EVALUATOR NAME: Yollanda Leon TELEPHONE: (714)703-2800 LICENSING EVALUATOR SIGNATURE: .z FACILITY REPRESENTATIVE SIGNATURE: -, ~ 'A~J ~_Mil-# " UC809 (FAS)- (01!/04) ~.-- DATE: 12105/2008 DATE: 12105/2008 Page: 2 of4 STATEOFCAUFORNIA - HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT (Cont) CAUFORNIA DEPARTMENT OF SOCW. SERVICES COMMUNITY CARE UCENStNG DMSKlN Otange Co. ChHdCB.NI', 750 ThO City Drtve,. $uite 250 Qranrut, CA 92868 FACILITY NAME: GOSPEL PRE-AFTER SCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I FACILITY NUMBER: 304370350 VISIT DATE: 12/0512008 DI;:FICIENCIES PLAN OF CORRECTIONS(POCs) Section Number Type A 12/0512008 Section Cited 101230(a) 1 Activities/Napping: Each center shall provide a variety of daily activities to meet the needs of the children in care, including but not limRed to quiet and activHies play and rest and relaxation • All children shall be given the opportunity to nap or rest without distraction 1 Licensee agrees to inform the parents that all children will be given the opportunity to nap or rest. Send to Licensing a copy of the parents notice and current schedule of daily activities. Licensee agrees to send her plan of correction to CCL by 2 3 4 5 8 7 2 3 4 5 6 7 8 Two children were napping in the large room, with 8 9 the front door Is wide open, , there is loud 10 distraction of noise, children and staff walking to 9 10 12/11/08. 11 the bathroom from classrooms to classroom, staff 11 1_2 entering and exiting' this is a distractionto tha . 121 13 children that are napping. 13 14 Type A 12/0512008 Section Cited 101238 14 1 Buildings and Grounds: Center to be clean, safe, 1 Licensee agrees to have the church adjust the wall 2 sanRary and in good repair : 2 partition Qividers, or to remove all items behind the 3 LPA observed there were two large wall dividers 4 located in the middle of the large classroom that 5 was not adjusted appropriately, behind the wall 6 partftion dividers there were 3 dividers, she agrees this Is a unsafe Issue to 4 children in care. Licensee agrees to send her plan 5 of correcllon to CCL by 1;1/08/08. 6 7 8 large speakers, television, mise items that are 9 hazard to day care children, next to the wall 10 dividers there were two preschool children that 11 were napping, this Is a hazard and unsafe to day 12 6are children. 8 9 7 13 14 10 11 12 13 14 Failure to correctthe cited deficlency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Dana Williamson TELEPHONE: (714) 703-2800 LICENSING EVALUATOR NAME: Yollanda Leon TELEPHONE: (714)703-2800 LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2008 my as FACILITY REPRESENTATIVE SIGNATURE: . DATE: 12/05/2008 ' This Notice must be posted for 30 days LIC8