STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT LA ChDd Cara East, 1000 Corporate Ctr Dr~B Mont FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: STOWE, YOLANDA 4835 LONG BEACH BLVD. ADDRESS: CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: MET WITH: Amy Leonard Perk, CA917S4 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: CENSUS:21 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562) 728·6882 90805 01/24/2005 03:15PM 05:30PM NARRATIVE 1 i During a case management visit at the above facility, LPA Harewood, observed, Robin Walker, Teacher, ~I 4. visually supervising preschoolers during outside play, without fingerprint clearance to the above facility. Mrs. Yolanda Stowe, Director, was present at this visit, however, LPA met with Amy Leonard, Administrator. 61 The above deficiency is a violation of Title 22, Division 12, Chapter 3 of the Manual of Policies and Procedures and must corrected to protect the health & safety of children in care. 5! 7i 8 9 Exit interview conducted with Amy Leonard. Appeal rights discussed and provided. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323)981-3365 LICENSING EVALUATOR NAME: Katherine Harewood TELEPHONE: (323)981-3384 LICENSING EVALUATOR SIGNATURE: -SIGNED*"* DATE: 01/24/2005 I acknowledge receipt of this form and understsnd my licensing appeal rights as explained and received_ FACILITY REPRESENTATIVE SIGNATURE: *'*SIGNED- DATE: 01/24/2005 This report must be available at the facUlty for public review (3 years). uceoa (FAS)- (06/04) Page: 1 Of 1 NOTICE OF SITE VISIT BY A CHilD CARE liCENSING OFFICE REPRESENTATIVE A stte vistt or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 05/23/2006 1. Were regulatory violations issued during this visit? l:8l Yes D 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected {Type A)? l:8l Yes D No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected {Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) D Yes D No No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care faciltty is required to post a copy of today's site visit report, you may view the report at the faciltty or obtain one by contacting the local Child Care Regional Office at: LA Child Care East 1000 Corporate Ctr Dr 200-B Monterey Park, CA 91754 Regional Office Contact Person: Katherine Harewood Contact Person Telephone Number: (323)981-3384 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 tFAS) - (1/04) STATE OF CALIFORNIA- HEALTlf AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) LA Child Care East, 1000 Corporate ctt Dt 200-B Monterey Park, CA 91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type PDC Due Dale I Section Number FACILITY NUMBER: 198007432 VISIT DATE: 09/02/2005 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type A 09/13/2005 Section Cited 101217(a)(6) 1 Personnel Records 2 Staff personnel, Monette Payne, had no 3 documentation otthe educational background, 4 training and/or experience available In personnel 5 file for review. 6 7 1 Obtain educational documentation by 9/13/05 and 2 forward to CCL for verlftcatlonlon. 3 4 5 6 7 Type A 09/13/2005 Section Cited 101216.1(b)(1) 1 Teacher Qualifications & Duties 2 Ms. Payne was hired without proper verflcation of 3 educational requirements to be a teacher. 4 5 6 7 1 Obtain educational documentation by 9/13/05 and 2 forward to CCL for file retention. 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 1 2 3 4 5 6 7 4 5 6 7 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323)981-3365 LICENSING EVALUATOR NAME: Katherine Harewood TELEPHONE: (323)981-3384 LICENSING EVALUATOR SIGNATURE: -SIGNED- DATE: 09/02/2005 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: -SIGNED ... DATE: 09/02/2005 This Notice must be posted for 30 days LIC009 (FAS) • (06104) Page: 2of 1 STATE OF CAUFORNlA~ HEALTH ANO HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVJCES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT LA Chid C8ra East, 1000 Corporate Ctr Dr 20Q..B Monttre Park, CA 91754 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: STOWE, YOLANDA ADDRESS: 4835 LONG BEACH BLVD. CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: MET WITH: Shurpree Jenkins FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: CENSUS: 13 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 09/02/2005 02:00PM 04:00PM NARRATIVE 1 2 3 4 During a Case Management visit on this date, during file review for staff, LPA observed for staff personnel Monette Payne, no transcripts or verification of education background. 5 6 7 8 9 10 11 12 13 14 15 16 171 18 19 I 20! 21 I 22' 231 241 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323)981-3365 LICENSING EVALUATOR NAME: Katherine Harewood TELEPHONE: (323)981-3384 LICENSING EVALUATOR SIGNATURE: -SIGNED- DATE: 09/02/2005 I acknowledge receipt of this form and understand my licensing appeal righta as explained and received. FACILITY REPRESENTATIVE SIGNATURE: -SIGNED ... DATE: 09/02/2005 This report must be available at the facility for public review (3 years). LICB09 (!'AS)· (06/04) Page: 1 of 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION LA Child care East, 1000 Corporate C1r Dt200-B LICENSEE/APPEAL RIGHTS (Cont) Monterey Park, CA 91764 Facility Name: BUNDLE OF JOY DAYCARE #3 Facility Number: 198007432 APPEAL PROCEDURES FOR APPLICANTS/LICENSEES One of your rights, as an applicant or licensee, is to file an appeal if you disagree with an action teken by the licensing agency. There are certain steps you must follow in order to ensure your concerns are heard. WHEN CAN YOU APPEAL? • If you disagree with a citation • If you have been assessed a civil penalty • If your application is denied or action is being teken to revoke your license WHAT ARE THE LEVELS OF APPEAL? Although there can be four levels of formal appeal of a licensing decision, you must start at the first level. This is to encourage review of your appeal as quickly as possible and to ensure that the decisions of licensing steff are reviewed by the appropriate supervisor. Any appeal made to the next level should include a clear explanation of what factor you feel was not adequately considered by the previous reviewer. Without an explanation provided by you the appeal review will be limited to the documents on which earlier decisions were based. Levels of appeal are as follows: 1. The Licensing Program Manager (LPM) or county equivalent 2. The Regional Manager (RM) 3. The Program Administrator (PA) 4. The Deputy Director, Community Care Licensing Division HOW AND WHEN DO YOU APPEAL? o If you disagree with a citation or penalty, file your appeal, with the Supervisor listed on the licensing report, in writing, within 10 days from the date you received the report or penalty assessment notice. " If you disagree with the decision made by the LPM, the second level of appeal must be made to the Regional Manager. The request for review must be made in writing after you receive the written decision from the LPM. • If you disagree with the decision made by the RM, the third level of appeal must be made to the PA. The request for review must be made in writing after you receive the decision made by the RM. • If you disagree with the decision made by the PA, the fourth level of appeal must be made to the Deputy Director. The request for review must be made in writing after you receive the decision made by the PA. " For denied application, follow the appeal instructions on the letter you were sent. For actions to suspend or revoke a license, follow the appeal instructions in the material served upon you by mail or in person. APPEAL RIGHTS- {FAS 00105} Page: 2 or 2 STAT!; OF CAUFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORrfiA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION LA Child Care East, 1000 Corporate ctr Dr 2QO.B LICENSEE/APPEAL RIGHTS Monterey Park, CA 91754 Facility Name: BUNDLE OF JOY DAYCARE #3 Facility Number: 198007432 Site Visit Rights 1. The right to require licensing field staff to identffy themselves. 2. The right to be advised of the type of visit, whether annual site visit, complaint, plan of correction (POC), pre-licensing, or some other type. When a site visit is made to investigate a complaint, the site Visit rights described in subsections (4) and (9) shall be applicable at the completion of the investigation. 3. The right to be treated as a professional and with dignity and respect. 4. The right to receive an accurate report of the evaluator's findings listing each observed deficiency. Each deficiency shall be separately numbered, so as to clearly indicate the number of deficiencies, shall be accompanied by a number which corresponds to a section of law or licensing regulation, and shall include a description of the evaluator's observation which led to the finding of a deficiency. The description of the evaluator's observation shall include a clear explanation of why the existing condition constitutes a deficiency, unless the description of the observation provided such an explanation. 5. The right to review licensing laws, regulations and policy. 6. The right to an impartial investigation of all complaints. 7. The right, at the time of the visit, to determine and develop a plan of correction for deficiencies cited. 8. The right to use licensing reports as a means to agree or disagree with cited deficiencies. 9. The right to an exit interview upon completion of the visit and to receive a signed copy of the licensing report. 10. The right to be informed on the licensing report of the evaluator's supervisor and his/her telephone number. 11. The right to access to the public file on any facility and the right to purchase a copy at a reasonable cost. Initial Appeal Rights 1. The right, without prejudice, to appeal any decision, any failure to act according to law or regulation, or any failure to act within any specified time line, through the licensing agency up to the Deputy Director. Appeal procedures are on the following form. 2. The right to request a meeting with the Regional Manager to discuss any licensing issue and with notice to bring any person to the meeting. 3. The right to due process and the option of bringing a representative to any administrative action. 4. The right to file a formal complaint, and receive a written response to that complaint within 30 days, for any licensing issue not covered by the appeal rights listed above, including, but not limited to, inappropriate behavior of department employees. APPEAL RIGHTS· (FAS 08/05) Page: 1 of2 STATE OF CAUFORNlA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DM!OON CIVIL PENALTY ASSESSMENT (Criminal Background Clearance) LA Child Cere Ea&t, 1000 Corporate Ctr Dr200-B FACILITY NAME Monterey Park, CA 91764 DATE BUNDLE OF JOY DAYCARE #3 05/23/2006 CITY FACI!..ITY ADDRESS 4835 LONG BEACH BLVD. LONG BEACH STATE ZIP CODE CA 90805 LICENSEE{S)fOPERATOR FACIUTY NUMBER STOWE, EDWARD & YOLANDA 198007432 lmm9dlate civil penalties can be assessed against any licensae for failure to comply with criminal background check requirements and against family child care licensees for failure to comply with parent/guardian notification and visit report posting requirements. See the back of this form for specffics. 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. IX! $100 Immediate Civil Penalty per person for allowing any person (who Is subject to a background check) to wcrk, reside or volunteer without a criminal record c!earance·or exemption. Maximum 5 days for first violation. 0 $100 Immediate Civil Penalty per parson for allowing any person (who is subject to a background check) to wcrk, reside or volunteer without a criminal record clearance or exemption. Maximur:n of :30 days for subsequent violatiOns. 0 $100 immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before requesting a clearance transfer or before receiving approval of an exemption transfer. 0 $100 Immediate Civil Penalty per parent/authorized representative for failure to provide 'Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Exclusion)". 0 $100 Immediate Civil Penalty per parent/authorized representalive for failure to provide 'Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Reinstatement)'. 0 0 0 $100 immediate Civil Penalty par parent/authorized representative for failure to obtain signature Indicating receipt of Addendum. $100 immediate Civil Penalty for failure to provide signed addendum to the Department when requested. $100 immediate Civil Penalty for failure to post the 'Notice of Site Visit Report" for 30 consecutive days. Individual #1 Jannice Moore numbar of days X $100 = $500.00 Penalty Individual #2 number of days X$100 = $0.00 Penalty Individual #3 number of days X $100 = $0.00 Penalty 5 Total $500.00 YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF UCENSING PROGRAM ANALYST Katherine Harewood SIGI'I~TURE OF LICENSING PROGRAM ANALYST NAME OF FACILITY REPRESENTATIVE/TITLE SIGN.!,TURE OF FACILITY REPRESENTATIVE SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 10/01/2014 mLE LIC421 B IFAS)-(05100) Page: 1 of2 STATE OF CALIFORNIA- HEALnl AND HUMAN SERVICES AGENCY CAUFORNIA DEPAAllAENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION FACILITY EVALUATION REPORT (Cont) LA Child Care East, 1000 Corporate ctr Dr :200·8 Monterey Pam, CA 91764 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Danclancy Type POC Due Date/ Section Number FACILITY NUMBER: 198007432 VISIT DATE: 05/23/2006 DEFICIENCIES Type A 05/24/2006 Section Cited 101229.1 1 SIGN IN/OUT 2 LPA observed in/out sheets to be incorrect. LPA 3 counted 30 children, only 24 had been sign ln. 4 5 6 7 Type A 05/24/2006 Section Cited 101221 1 2 3 4 5 6 7 CHILD'S RECORD During review of childrens' records, Child # 1,2 ,4 & 6 did not have the Physician's Report and/or It was on file but Incomplete. Child #1 ,4 & 6 had no heaHh history and/or the one on file was Incomplete. Child #3 had the medical consent on file but no chlld 1S name on it. Child #6 had no admission agreement of immunization record on file. PLAN OF CORRECTIONS(POCs) 1 Have ALL parents sign ALL children in and out 2 properly dally. 3 4 5 6 7 1 Update children's records immediately and 2 accurately. 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 dellclency(ies), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Robert Sanchez TELEPHONE: (323)981-3395 LICENSING EVALUATOR NAME: Katherine Harewood TELEPHONE: (323)981-3384 LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2006 I acknowledge receipt of this form and understand my appeal rights FACILITY REPRESENTATIVE SIGNATURE: This Notice must be posted for 30 days as explained and received. DATE: 05/23/2006 This Notice must be posted for 30 days macs (mm-{owns} Paga:2013 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVK:ES AGENCY CALifORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) LA Child Cara East.-1000 Corporate Ctr Dr 200.B Mcmtaray Park. CA 91764 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deflclency Typo POC Duo Date/ FACILITY NUMBER: 198007432 VISIT DATE: 05/23/2006 DEFICIENCIES PLAN OF CORRECTIONS(POCs) CRIMINAL RECORD CLEARANCE LPA Harewood observed, Jennice Moore, caring and supervision children without fingerprint clearance. Ms. Moore states she has been with facility for a few months. (LPA Harewood called OD desk at LACCE to see if 6 fingerprints were associated to above facility or ~t 7 least In the system- response from DD worker was no). Have Ms. Mccre fingerprinted Immediately. 1 ($500.00 penalty will be assessed). Uve scan form 2 was provided at this visH. 3 4 5 6 7 1 2 3 4 5 6 7 1 Make personner records available at all times for 2 review by CCL. 3 4 5 6 7 Section Number Type A Section Cited 101170 (a) Type A 05/24/2006 Section Cited 101217(a) Type A 05/24/2006 Section Cited 101227 (6) Type A 05/01/2006 Section Cited H&S 1596.841 1 2 3 4 5 PERSONNEL RECORDS No staff records were available for review. Staff did not know where the key was, therefore, analyst could not determine who was qualified as a teacher or aide. Assistant Director should have access to personnel records at any given time. 1 FOOD SERVICE 2 Menu was not posted for parents or CCL staff to 3 observe on parent board. 4 5 1 Create a complete menu and post on parent board 2 immedlalely. (Menu observed was for 3 days only). 3 4 5 6 6 7 7 1 CHILD CARE ROSTER 2 No child roster was available for review. 3 1 Create a roster for classroom/facility immediately. 2 3 4 5 6 7 4 5 6 7 Failure to correct the cited deficlency(ies), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Robert Sanchez TELEPHONE: (323)981-3395 LICENSING EVALUATOR NAME: Katherine Harewood TELEPHONE: (323)981·3384 LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2006 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2006 SUPERVISOR'S NAME: Robert Sanchez TELEPHONE: (323)981-3395 UCENSING EVALUATOR NAME: Katherine Harewood TELEPHONE: (323)981-3384 LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2006 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2006 This rsport must be available at the facility lor public review (3 years). LICBOO (FAS) • (06/04) Paga: 1 Of3 STAT: OF CALIFORNIA· HEALTH AND HUMAN SERVJCES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION FACILITY EVALUATION REPORT , 1000 Corporate Ctr Dr 200-B Montero Park, CA91754 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR:AYESHA AINSWORTH ADDRESS: 4835 LONG BEACH BLVD. LONG BEACH CITY: 45 CAPACITY: TYPE OF VISIT: Annual/Random MET WITH: Sheila Knowles Asst. Director FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: CENSUS:30 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 05/23/2006 01:20PM 04:30PM NARRATIVE I 1 An annuaVrandom visit was made on this date by LPA Katherine Harewood. Upon arrival, facility 2, was toured with Assistant Director, Shelia Knowles. Present at this visit were 30 children in two 31 separate areas. Sixteen children (ages 4 & 5) were observed in the school age area, napping. (No school age children were present at this time). The sixteen children that were napping were being supervised by teachers, Dana Pickett and Jennice Moore. The reason these children were in this area is because facility has prepared a room for LA UP. School age children arrive around 3:30pm, 7 after napping is complete and preschool children return to other preschool area and school age are then in this area. LPA observed preschoolers awakening around 3:00 pm to snacks and outside 10 I play. Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Napping equipment and bedding were 13! inspected for good condition, appropriate storage and cleanliness. Storage for children's belongings 141 15 I and an isolation area with sink, toilet, and mat/cot were inspected. Availability of drinking water was 16 reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water 17 temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were 18 inventoried. A review of medication policy, including administering, labeling, storage, and records 19 were made. 20 Snack/lunch menus were not available for review. Food and snacks were reviewed for availability, 21 quantity and appropriateness to children in care. Food preparation areas were toured for safety, 22 cleanliness and proper equipment. A review of cleaning and food supply storage areas were made. 23 Outdoor equipment were inspected for safety, cushioning material, good repair, and age 24 appropriateness. Required shade, drinking water and fencing were inspected. Play area was 25 inspected for hazards and inaccessibility to bodies of water. Teacher child ratios were observed and staff names recorded. Care and supervision were evaluated to determine if the basic needs 'of children are met and appropriate. Sign in and out sheets were reviewed and were incorrect Personal Rights of children were discussed and observed by LPA. Transportation policy and procedures were reviewed for safety requirements. Children records were reviewed. Staff records could not be reviewed because assistant director did not have the key.Staff members present at this visit were: Mirna Chinchilla, Shelia Knowles, Ronda Chaney, Imelda Covarrubias, Dana Picket, Jennies Moore, Betty Reed-Driver, Cynthia Manjarrez -ROP student and Kitchen staff: Doris Saldivar & Gloria Trujillo. The deficiencies listed on page 2 were observed by the LPA and are being cited In accordance with California Code of Regulations Title 22 Dlv. 12. 4 5 6 ~I gl The deficiencies cited needs to be cleared to protect the children's health & safety within 14 days of this visit. Exit Interview was conducted with Sheila Knowles. Appeal Procedures discussed and Issued. Site VIsit Notice Posted. To Clear Additional POC's Use Button on 809-D STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CLEARED DEFICIENCIES FACILITY NAME: BUNDLE OF JOY DAYCARE CALFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION LA Child care East, 1000 Corp. Ctr Dr 2008 Monterey,CA91754 #3 FACIUTVNUMBER: 198007432 VISIT DATE: 08/16/2006 POC Due Date I Section Number 08/18/2006 101216.3(a) 08/18/2006 Section Cited PLAN. OF CORRECTIONS(POCs) Please submit a written statement to the Department outlining 4 fNhat steps shall be taken to ensure the appropriate 5 eacher-<:hlld ratios are maintained at this facility as this further 6 ~nsure the lieallh and Safety of children in care. 7 1 2 3 6 7 1 2 3 4 5 6 7 Section Cited I 1 ~ 4 5 Section Cited Date Cleared Comments 1 2 3 4 5 6 7 OB/16/2006 1 2 LPA received a Jetter from Director Stowe 3 stating techer-child ratios shall be 4 adequately maintained in the facility. 1 2 3 4 1 2 3 4 1 2 3 4 Control Number 33-CC-20060804125126 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE UCENSING DMSION COMPLAINT INVESTIGATION REPORT (Cont) Ia child care eaat. 1000 Corp. ctr Of 2008 Mantere , CA!I1764 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Duo Date I FACILITY NUMBER: 198007432 VISIT DATE: 08/16/2006 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number Type A 08/18/2006 Section Cited 101216.3(8) 1 2 3 4 5 6 7 08/18/2006 1 2 3 4 5 6 TEACHER-CHILD RATIO. LPA Zaragoza arrived a1 this program and obseiVed (1) qualified teacher supeiVising (6) preschool children and (13) school-aged children. This occured from 7:30 A.M. -7:50A.M. Additional staff subsequently arrived and raitos were corrected. 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Please submit a written statement to the Department outlining what steps shall be taken to ensure the appropriate teacher-child ratios are maintained at this facility as this further ensure the Health and Safety of children in care. 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(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. · SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 981-3371 UCENSING EVALUATOR SIGNATURE: DATE: 08/16/2006 i acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2006 This Notice must be posted for 30 days LIC9W9 (FAS) ~ (06/04} Page: 2 of5 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCiAL SERVlCES COMMUNITY CARE UCENSING DMSION LA Child Care East 1000 Corp. C1r Dr 200B Monterey, CA 91754 12/12/2008 BUNDLE OF JOY DAYCARE #3 198007432 4835 LONG BEACH BLVD. LONG BEACH, CA 90805 Letter of Deficiency. Citations Cleared Dear Ucensee, The following deficiencies, in~ially cited during a vis~ on 10/16/2008, have been cleared: Section Cited: 101216.3(a} Plan of Correction: Ucansee agrees to submit a plan In writing outlining what steps shall be taken to ensure that this preschool program opemtes within the required teacher • child ratio during hours of operation of this preschool as 1hls further ensures 1he Heanh and Safety of children In Date Due: 10/17/2008 Corrections: Ucensee has stated this progrm will operate In compliance with teacher--child ratlos Clearance Date: 12/05/2006 care. LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 LICENSING EVALUATOR SIGNATURE: ~~ 1)~'{· DATE: 12/12/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleartd POC Letttr (FAS) ~ (04/05) Page: 1 of 1 All POC Have Been Cleared STATE OF CALIFORNIA- HEALTH AND HUMAN SERVK:ES AGENCY CALIFORNIA DEPARTMENT OF SOClAL SERVICES COMMUNITY CARE UCENSlNG DMSION CLEARED DEFICIENCIES LA Child care East, 1000 corp. Ctr Dr 200B Monterey, CA91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 FACILITY NUMBER: 198007432 VISIT DATE: 10/16/2008 POC Duo Date/ Section Number 10/17/2008 101216.3(a) Date Cleared 1 Comments PLAN OF CORRECTIONS(POCs) 1 2 Ucensee agrees to submit a plan ln writing outlining what 3 ~eps shall be taken to ensure thai this preschool program 1 12/05/2008 Licensee has stated this progrm will 2 4 pperates within the required teacher- child ratio during hou~lth 3 operate in compliance with teacher-child 5 operation of this preschool as this further ensures the Heal 4 ratios 6 ~nd Safety of children in care. pi 7 Section Cited 1 2 3 4 5 6 1 2 3 4 7 Section Cited 1 2 3 4 5 6 7 Section Cited 1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 Control Number 33-CC-20081 009150956 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMJAUNITY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT (Cont) LA Chid Ctlre East, 1000 Corp. Ctr Dr2.00B Monterey, CA 91754 FACILITY NUMBER: 198007432 VISIT DATE: 10/16/2008 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type PDC Due Date/ Section Number Type A 10/17/2008 Section Cited 101216.3(a) PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 7 TEACHER-CHILD RATIO. On 10/09/08, 1 teacher was left to supervise 18 children in a preschool classroom. This staff was alone with 1B children from 8:50A.M. Teacher-child ratios were not restored to regulatory requirements on this date as two aides subsequently arrived at 1:57 P.M and 2:59 P.M. 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 1 2 3 4 5 6 7 Ucensee agrees to submit a plan in writing outlining what steps shall be taken to ensure that this preschool program operates within the required teacher - child ratio during hours of operation of this preschool as this further ensures the Health and Safety of children In care. Failure to correct the cited deficiency(ies), on or be!cre the Plan of Correction (POC) due date, may result In a civil penalty assessment SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 ""'W~Z DATE: 10/16/2008 I acknowledge receipt of this !crrn and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: . /[} -__41' ( /J.P4/d ,/ {// ~ DATE: 10/16/2008 } This Notice must be posted for 30 days l..JC9tll)9 (FAS)- {06104) Page: 3 of 3 Control Number 33-CC-20081 009150956 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) LA Child Care East, 1000 Corp. CtrDr200B Monter , CA 917B4 FACIUTY NUMBER: 198007432 VISIT DATE: 10/16/2008 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 NARRATIVE 1 2 3 4 5 6 7 8 9 Time cards show add~ional staff did not arrive unlil1 :57 P.M. and an additional staff arrived at 2:59P.M. Both of these subsequent staff arrivals were aides. The lead teacher confirmed what records showed for the business day of 10/09/08. The following deficiency is cited in accordance with Title 22 Regulations for Child Care Centers as indicated on the page that follows. An exit interview was conducted and LPA presented an Appeal Rights form (LIC 9058). 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: Knuta Martin TELEPHONE: (323) 981 -3365 UCENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 uc'"~WA~"" DATE: 10/16/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 10/16/2008 LJC0099 (FAS) • (.....) Page: 2 of3 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAl. SERVICES COMMUNrTY CARE LICENSING DIVIIOON COMPLAINT INVESTIGATION REPORT LA Child Care East, 1000 Corp. Ctr Dr 2009 Monterey, CA91754 This is an official report of an unannounced visit/investigation of a complaint received in our office on 1 0/09/2008 and conducted by Evaluator Paul Zaragosa PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20081009150956 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: AYESHA AINSWORTH 4835 LONG BEACH BLVD. ADDRESS: CITY: LONG BEACH CAPACITY: 45 MET WITH: Carla Lee FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE: CENSUS: 22 DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 10/16/2008 09:00AM 11:45AM ALLEGATION(S): 1 1). Teacher-Child Ratio. On 10/09/08, one teacher was observed in classroom with 13 children. 2 3 4 6 6 7 8 9 INVESTIGATION FINDINGS: 1 Licensing Program Analyst Zaragoza met with lead teacher, Carla Lee, to discuss the above-referenced 2 allegation. Today's census comprised of 12 LAUP preschool children and 10 additional preschool children. 3 4 LPA reviewed sign-in in sheets and determined 27 children were present In the preschool program on 5 10/09/08. Time cards reflect that one qualified teacher and one cook/aide were present at 6:03A.M. At 7:03A.M., an LAUP preschool teacher arrived. 6 7 8 9 LAUP commenced at 8:00 A.M. on 10/09/08. By 8:10 A.M., the LAUP program had a ratio of 1 teacher to 9 children. This program was within the required teacher-child ratio. However, by 8:50A.M., records show that 10 another teacher in a separate preschool classroom was alone with 18 children. 11 12 13 Estimated Days of Completion: Substantiated TELEPHONE: (323) 981-3365 SUPERVISOR'S NAME: Knute Martin LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 LICENSING EVALUATOR SIGNATURE: :v~ ~~·i· DATE: 10/16/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACIUTY REPRESENTATIVE SIGNATURE: /J / .,?" ~ ~~ /Ji ~ / (.. ,. ./ DATE: 10/16/2008 ~ This report must be available at Child Care and Grcup Home facilities for public review for 3 years. UC90it9 (FAS) • (06/04) Page: 1 or 3 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 10/16/2008 1. Were regulatory violations issued during this visit? [gJ Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected {Type A)? [gJ Yes D No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) D [gJ No Yes ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: LA Child Care East 1000 Corp. Ctr Dr 2008 Monterey, CA 91754 Regional Office Contact Person: Paul Zaragosa Contact Person Telephone Number: (323) 219-5525 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC92l3 (FAS) • (1/04) STATE OF CAUFORNIA ~HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CAFI:E UCENSitfG OMS ION LA Child Care East 1000 Corp. Ctr Dr 200B Monterey, CA 91754 12/12/2008 BUNDLE OF JOY DAYCARE #3 198007432 4835 LONG BEACH BLVD. LONG BEACH, CA 90805 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, inmally ctled during a visit on 10/16/2008, have been cleared: Section Cited: 101170(e)(2) Plan of Correction: Ucensee agrees to submit a pian in writing outlining what steps shall be taken to ensure that requests for new staffs transfer of a criminal recortl Clearance wl!i be submitted to the Department prior to Initial presence in the preschool program as this further ensures the Health and Safety cr.' children receiving care. LICENSING EVALUATOR NAME: Paul Zaragosa Date Due: 10/17/2008 Corrections: Clearance Date: Ucensee stated that all future criminal 10/17/2008 record clearances shaJI be verified and associated prior to staff prescence in this program. TELEPHONE: (323) 219-5525 LICENSING EVALUATOR SIGNATURE: :PJ\ ;y){i\ DATE: 12/12/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. Clellltd POC LoHer (FAS) ~ (04105) PagD: 1 of 1 All POC Have Been Cleared STAT: OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CLEARED DEFICIENCIES CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE l.ICENSING DMSION lAOllld care East, 1000 Corp. Ctr Dr 2008 Montara • CA 91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 FACILITY NUMBER: 198007432 VISIT DATE: 1011612008 POC Due Date I Section Number 10/17/2008 101170(e)(2) Section Cited Date Cleared I Comments PLAN OF CORRECTIONS(POCs) ~ Ucansee agrees to submit a plan in writing outlining what 1 taps shall be taken to ensure that requests for new staffs ransfer of a criminal record clearance will be submitted to the 2 Department prior to Initial presence In the preschool program 3 4 s t~l~ further ensures the Health and Safety of children rece~vtng care. 7 3 4 5 6 1 2 3 4 5 6 7 1 2 3 4 1 Secllon Cited 2 3 4 5 6 7 Section Cited 1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 10/17/2008 Ucensee stated that all future criminal record clearances shall be verified and associated prior to staff prescence in this program. STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNlA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION CIVIL PENALTV ASSESSMENT- IMMEDIATE LA. Child Catct Eaat, 1000 Corp. ctt Dr 2009 Montert , CA 91754 FACILfTY NAME DATE BUNDLE OF JOY DAYCARE #3 10/16/2008 FACUJTY ADDRESS CITY 4835 LONG BEACH BLVD. LONG BEACH ZIP CODE STATE 90805 CA UCENSEE~~PERATOR FACILITY NUMBER BUNDLE OF JOY DAY CARE INC. 198007432 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 parenVguardian notification and visit report posting requlrements.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 (UC 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 volunteer without a criminal record clearance or exemption. Maximum 5 days for first violation. 0 $1 oo immediate Civil Penalty per person for allowing any person (who is subject to a background check) to work, reside or volunteer without a criminal record clearance or exemption. Maximum of 30 days for subsequent violations. ~ $100 Immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before requesting a clearance transfer or before receMng approval of an exemption transfer. 0 $1 oo immediate Civil Penalty per parenVauthorized representative for failure to provide "Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Exclusion)". 0 $100 immediate Civil Penalty per parenVauthorized representative for failure to provide "Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Reinstatement)". 0 0 0 $100 immediate Civil Penalty per parent/authorized representative for failure to obtain signature indicating receipt of Addendum. $1 00 Immediate Civil Penalty for failure to provide signed addendum to the Department when requested. $t 00 immediate Civil Penalty for failure to post the "Notice of Site Visit Report" for 30 consecutive days. Individual #1 LASHONA HUGHES number of days X $100 = $100.00 Penalty Individual #2 number of days 1 X$100 = $0.00 Penalty lndividual#3 numberofdays X$100= $0.00 Penalty $100.00 Total YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Paul Zaragosa ·-:pJ'~~ NAME OF FACILITY REPRESENTATIVE/TITLE CARLA LEE "21~:~-;; :t:ltm d~~-.... .L SUPERVISOR REVIEW SIGNATURE (FOR INTERNAl USE ONLY) DATE 10/16/2008 TITLE LIC42fB (FAS) • (06108) Page: 1 or2 STATE CF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) LA Child care Eaet, 1000 Corp.Ctr Dr200B Monter FACIUlY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deflclency Type POC Due Date/ Section Number Type A 10/17/2008 Section Cited 101170(e)(2) FACILITY NUMBER: 198007432 VISIT DATE: 10/16/2006 DEFICIENCIES 1 2 3 4 5 6 7 CRIMINAL RECORD CLEARANCE. LPA toured the preschool program and met wah a staff working In this preschool program. The staff stated she Is a "substituten working here today. The staff has a criminal record clearance. However, no proof could be provided to demonstrate a request for transfer of a criminal record clearance had been made. Records show a partially ccmpleted (LIC 91 82) that was dated 10/10/08. · , CA 91754 PLAN OF CORRECTIONS(POCs) 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 1 2 3 4 5 6 7 Ucensee agrees to submit a plan in writing outlining what steps shall be taken to ensure that requests for new staff's transfer of a criminal record clearance will be submitted to the Department prior to lnHial presence In the preschool program as this further ensures the Health and Safety of children receiving care. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a cMI penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa ~~:J-dA(\{'""" TELEPHONE: (323) 219-5525 DATE: 10/16/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: (}~/~~ DATE: 10/16/2008 This Notice must be posted for 30 days LIC809 (FAS}- (06/04) Page: 2 ot 2 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSIDN FACILITY EVALUATION REPORT LA Child Care Earrt, 1000 Corp. Ctr Dr 2009 Monterty, CA 91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR:AYESHA AINSWORTH 4835 LONG BEACH BLVD. ADDRESS: CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: Case Management MET WITH: Carla Lee FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: CENSUS: 22 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 10/16/2008 09:00AM 11:45AM NARRATIVE 1 2 3 4 5 6 7 8 9 10 In conjunction with a field visit made to this preschool the following deficiency was observed in accordance with Title 22 Regulations for Child Care Centers as indicated on the page that follows. An exit interview was conducted and LPA also presented an Appeal Rights form (LIC 9058). . 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Knu1e Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 UO~ruAWA~'{:g DATE: 10/16/2008 1acknowledge receipt of this fonn and understand my licensing appeal righta as explained and received. FACILITY REPRESENTATIVE SIGNATURE: /I 4ar?L~7 DATE: 10/16/2008 This report must be available at Child Care and Group Home fscllltles for public review for 3 years. UCl!Oll (FAS) • (06/04) Page: 1 Of2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 11/06/2008 1. Were regulatory violations issued during this visit? lXI Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the heatth and safety of children in care, if not corrected (Type A)? lXI Yes D No 3. If regulatory violations were cited, could they become a risk to the heaith, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) lXI Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: LA Child Care East 1000 Corp. Ctr Dr 200B Monterey, CA 91754 Regional Office Contact Person: Paul Zaragosa Contact Person Telephone Number: (323) 219-5525 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 (FAS) -{1104) STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSIOr. LA Child Care East 1000 Corp. Ctr Dr 200B Monterey, CA 91754 12/12/2008 BUNDLE OF JOY DAYCARE #3 198007432 4835 LONG BEACH BLVD. LONG BEACH, CA 90605 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 11/06/2008, have been cleared: Section Cited: 101161 (a) Date Due: 11/07/2008 Plan of Correction: Corrections: Clearance Date: Ucensee submitted a statement in 11113/2008 writing Indicating that there shall be adequate staff for respective programs Ucensee agrees to submit a plan In writing outlining what steps Shall be taken to ensure that children In multiple programs operating on this slte are not commingled as this further ensure the Health and Safet.y of children receiving care in this program. Section Cited: 101170(e)(2) Plan of Correction: Ucensee agrees to submit a plan In writing outlining what steps shall be tal(en to ensure that requests for new staffs transfer of a criminal record clearance will be submitted to the Department prior to Initial presence in the preschool program as this further ensures the Health and Safety of chlidren receiving care. LICENSING EVALUATOR NAME: Paul Zaragosa operating on this site. Date Due: 11/07/2008 Corrections: Ucensee submitted a stament In writing lndlcaUon that all future Clearance Date: 11/13/2008 employees will be associated and/or obtain criminal record clearances prior to presconce in this program. TELEPHONE: (323) 219-5525 LICENSING EVALUATOR SIGNATURE: /R~ ·2t){i\ DATE: 12/12/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleartd POC Letter (FAS) • {04/05) Pago: 1 or 1 All POC Have Been Cleared STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVlCES COMMUNITY CARE LICENSING DIVISION CLEARED DEFICIENCIES LACtllld Care East, 1000 Corp. Ctr Dr20DB Montara ,CA91754 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 FACILITY NUMBER: 198007432 VISIT DATE: 11/06/2008 POC Due Date I Dale Cleared I Comments PLAN OF CORRECTIONS(POCs) Section Number 11/07/2008 101161(a) 11/07/2008 Section Cited 101170(e)(2) Section Cited 1 2 ~censee agrees to submit a plan In wriUng outlining what 3 teps shall be taken to ensure that children in multiple 4 rograms operating on this site are not commingled as this 5 1urlher ensure the Health and Safety of children receMng care 6 n this program. 7 11/13/2008 Ucensee submitted a statement in wrltlng Indicating that there shall be adequate staff for respective programs operating on this site. 11/13/2008 Licensee submitted a stament in writing taps shall be taken to ensure that requests for new staffs ~ Indication that all future employees will 3 be associated and/or obtain criminal 4 ransfer of a criminal record clearance will be submitted to the 5 Department prior to initial presence In the preschool program 3 record clearances prior to prescence In 4 6 ~s this further ensures the Health and Safety of children this program. 7 receiving care. ~ 1 2 3 4 5 6 7 Section Cited 1 2 3 4 1 2 3 4 5 6 7 Ucansee agrees to submit a plan in writing outlining what 1 2 3 4 1 2 3 4 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNTTY CARE UCENSING OMSION LA Child Care East 1000 Corp. C1r Dr 200B Monterey, CA 91754 12/12/2008 BUNDLE OF JOY DAYCARE #3 198007432 4835 LONG BEACH BLVD. LONG BEACH, CA 90805 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, lnttially cHed during a visit on 11/06/2008, have been cleared: Section Cited: 101215.1(a)(f) Plan of Correction: Ucensee agrees to submtt a plan fn writing outlining what steps shalt be ta!cen to ensure that there Is a qualified Director working In this program in order to ensure accountability in the overall operation of this program. This also further ensures the health and safety of all chlldrsn receiving care In this facility. Date Due: 11/10/2008 Corrections: LPA received ceritiflcation from Ucensee indicating Yolanda Stowe shall be Director of this program. Clearance Data: 12/11/2008 LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 ""·?~""~\{"'' DATE: 12/12/2008 This report must be available at Child Care and Group Home laciiiUes for public review for 3 years. Claartd POC LeHar (FAS} ~ (04/05) Page: 1 of 1 All POC Have Been Cleared STATE OF CALIFORNIA w HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION CLEARED DEFICIENCIES LA. Chid Care East. 1000 Carp. Ctr Dr 200B Montero , CA 91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 POC Due Date/ FACILITY NUMBER: 198007432 VISIT DATE: 11/06/2008 Date Cleared I Comments PLAN OF CORRECTIONS(POCs) Section Number 11/10/2008 101215.1(a)(~ 1 2 Ucensee agrees to submtt a plan In writing outlining what 3 teps shall be taken to ensure that there Is a qualified Director 4 !working In this program in order to ensure accountability In the 5pverall operation of this program. This also further ensures the 6 ealth and safety of all children receiving care in this facility. 1 12/11/2008 2 LPA received cerltlflcatlon from Ucensee Indicating Yolanda Stowe shall be 3 4 Director of this program. 7 Section Cited 1 2 3 4 5 6 7 Section Cited 1 2 3 4 5 6 7 Soct!on Cited 1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 1 2 3 4 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE liCENSING DMSION CIVIL PENALTY ASSESSMENT -IMMEDIATE LA Child care East, 1000 Corp. Ctr Dr 2009 Monterey, CA91754 DATE FACILITY NAME BUNDLE OF JOY DAYCARE #3 11/06/2008 crrv FACiLITY ADDRESS 4835 LONG BEACH BLVD. LONG BEACH ZIP CODE STATE 90805 CA FACILITY rtUMBER UCEN:SEE(S)/OPERATOR 198007432 BUNDLE OF JOY DAY CARE INC. 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 parent/guardian 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 aJiowing any person (who is subject to a background check) to work, reside or volunteer without a criminal record clearance or exemption. Maximum 5 days for first violation. D $100 Immediate Civil Penalty per person for allowing any perscn (who is subject to a background check) to work, reside or volunteer without a criminaJ record clearance or exemption. Maximum of 30 days for subsequent violations. ~ $100 Immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before requesting a clearance transfer or before receiving approval of an exemption transfer. D $100 immediate Civil Penalty per parent/authorized representative for failure 1o provide 'Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Exclusion)'. D $100 Immediate Civil Penalty per parent/authorized representative for failure to provide 'Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Reinstatement)". D $100 Immediate Civil Penalty per parent/au1horized representative for failure to obtain signature Indicating receipt of Addendum. D D $100 immediate Civil Penalty for failure to provide signed addendum to the Department when requested. $100 Immediate Civil Penalty for failure to post the "Notice of Site Visit Report" for 30 consecutive days. lndMdual #1 BESSIE WILLIAMS number of days X$100 = $500.00 Penalty Individual #2 number of days X$100= $0.00 Penalty Individual #3 numbar of days X $100 = $0.00 Penalty 5 Total $500.00 YOU WILL RECEIVE A BILL IN THE MAIL DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILLI NAME OF LICENSING PROGRAM ANALYST Paul Zaragosa ··~:or~= NAME OF FACILITY REPRESENTATIVE/TITLE CARLA LEE SIGNATURE OF FACILITY REPRESENTATIVE ?~,-;1Jdfk, / SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 11/06/2008 TITLE UC421B (FAS) ~ (05/06} Page: 1 or2 STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION FACILITY EVALUATION REPORT (Cont) LA Ctilld Care East, 1000 Corp. ctr Dr 2008 Monterey, CA 91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 FACIUTVNUMBER: 198007432 VISIT DATE: 11/06/2008 DEFICIENCY INFORMATION FOR THIS PAGE: Deftcfency Type POC Due Date I Secffon Number DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type A 11/07/2006 Section Cited 101161(a) 1 2 3 4 5 6 7 LIMITATIONS ON CAPACITY AND AMBULATORY STATUS. Although licensed to separately provide care for school-aged children, LPA observed (12) preschool ct>lldren and (1) school aged child commingled and receiving care in one section of the preschool program. 1 2 3 4 5 6 7 Type A 11/07/2006 Section Cited 101170(e)(2) 1 2 3 4 5 6 7 CRIMINAL RECORD CLEARANCE. LPA toured the preschool program and met with a staff working in this preschool program. The staff stated she Is a "substitute• teacher. She has worked here on at least (5) occasions. The staff has a criminal record clearance. However. no proof could be provided to demonstrate a request for transfer of a criminal record clearance had been made. Records show a partially completed (UC 91 62) that was dated 09/09/06. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 1 2 3 4 5 6 7 4 5 6 7 Licensee agrees to submit a plan In writing outlining \Nhat steps shall be taken to ensure that children in multiple programs operating on this site are not commingled as this further ensure the Health and Safety of children receiving care In this program. Licensee agrees to submit a plan In writing outlining what steps shall be taken to ensure that requests for new staffs transfer of a criminal record clearance will be submitted to the Department prior to initial presence in the preschool program as this further ensures the Health and Safety of children receiving care. Failure to correct the cited deflclency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 "'Pl'-~~T"" DATE: 11/06/2008 I acknowledge receipt of this fonn and understand my appeal rights as explained and received. FACIUTV REPRESENTATIVE SIGNATURE: .Q~~ DATE: 11/06/2008 This Notice must be posted for 30 daya Page: 3 of3 STATE OF CALfFORNIA ·HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LlCENSING CMSION FACILITY EVALUATION REPORT (Cont) LA Child caro east. 1000 Corp. Ctr Dr 2008 Montara , CA 91754 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number TypeB 11/10/2008 Section Cited 101215.1 (a)(ij FACILITY NUMBER: 198007432 VISIT DATE: 11/06/2008 DEFICIENCIES 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) CHILD CARE CENTER DIRECTORS QUALIFICATIONS AND DUTIES. There has not been a qualified Director working in this program for at least (30) days and an interim and/or qualified replacement director has not been hired. 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 1 2 3 4 5 6 7 Ucensee agrees to submit a plan in writing outlining what steps shall be taken to ensure that there is a qualified Director working In this program in order to ensure accountability In the overall operation of this program. This also further ensures the health and safety of all children receiving care In this facility. 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: Knute Martin TELEPHONE: (323) 981-3365 TELEPHONE: (323) 219-5525 LICENSING EVALUATOR NAME: Paul Zaragosa LICENSING EVALUATOR SIGNATURE: ?~ 75{\{, DATE: 11/06/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: /1 /~ V .IIA'~.J~ I.IC800 (FAS)- (06tll4) DATE: 11/06/2008 ) Pago: 2 Df3 STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT LA Child Care Eaat, 1000 Corp. Clr Dr 2008 Monterey, CA 91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR:AYESHA AINSWORTH 4835 LONG BEACH BLVD. ADDRESS: CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: Case Management Carla Lee MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA CENSUS:23 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 11/06/2008 09:30AM 11:30AM NARRATNE 1 2 3 4 5 A field visit made to this preschool today. Licensing Program Analyst Zaragoza met with lead teacher, Carla Lee. LPAtoured the preschool, recorded staff names and observed teacher-child ratios. 6 After a tour of this program, the following deficiencies were observed in accordance with Title 22 Regulations for Child Care Centers as indicated on the page that follows. An exit interview was conducted and LPA also presented an Appeal Rights form 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 (LIC 9058). I 221 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 LICENSING EVALUATOR SIGNATURE: ~~~~i DATE: 11/06/2008 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: /' ~ l1 {_/7 /)~~.<~ DATE: 11/06/2008 This report must be available at Child Care and Group Home facilities for public revfew for 3 years. L.,.,. (FAS)- (06104) Page: 1 of3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT LA ChUd Care East, 1000 Corp. Ctr Dr 2009 Mon!ere , CA 91754 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR:AYESHA AINSWORTH ADDRESS: 4835 LONG BEACH BLVD. CITY: LONG BEACH 45 CAPACITY: TYPE OF VISIT: Office MET WITH: Yolanda Stowe 1 2 3 4 5 FACIUTY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: DATE: CENSUS:O UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562} 728-6882 90805 12/05/2008 02:00PM 03:00PM NARRATIVE Ucensing Program Manager Knute Martin and Licensing Program Analyst Zaragoza met with Bundle of Joy, Inc. executive director, Yolanda Stowe to discuss the history of deficiencies cited against the Bundle of Joy #3 preschool program. The following citations were discussed: • 11/06/08: Limitations on Capacity and Ambulatory Status. A school-aged child was commingled with preschool children. 7 • 11/06/08: Criminal Record Clearance. Staff working without criminal record clearance association. 8 9 10/16/08: Teacher-Child Ratio. 1 staff left to supervise 18 children. 10 • 05/23/06: Criminal Record Clearance. Adult on site without a criminal record clearance. 11 • 05/23/06: Personnel Records. Not available for review. 12 • 09/02/05: Personnel Records. No records to support staff position on file. Teacher Qualifications. No 13. records to support. • 01/26/05. Teacher Qualifications. 1 aide left with 10 children. • 01/24/05. Criminal Record Clearance. Staff working without any clearance. 16 17 Executive Director, Yolanda Stowe, stated that she shall substantially comply with Title 22 Regulations and no 18; deficiencies will be found during any Mure visits made by the Department. 19' 20 This preschool program will be placed on a required visit status for a two year period and must demonstrate substantial compliance with Title 22 Regulations. Further, if this program continues to demonstrate an inability 21 22 to comply with Title 22 Regulations, the Department will refer this program to our Legal Division for further 23 consideration including the possibility of seeking an Administrative action against the Licensee. Finally, the 241 Department will be conducting a complete review of all Bundle of Joy, Inc. licensed facilities to determine 25. whether additional actions may be warranted. 6 141 151 No administrative action shall take place at this time. However, this child care center shall be subject to a re ulred visit to ensure substantial com lienee with Title 22 Re ulations. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323} 981-3365 TELEPHONE: (323} 219-5525 LICENSING EVALUATOR NAME: Paul Zaragosa LIC:::;~UAT~~;IGNATU~E/ D ~ -~/~I) rtw~\ !2!1\ I · U\\'1\ DATE: 12/05/2008 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2008 This report must be available at Child Care and Group Home faciiHies lor public review lor 3 years. UCS09 (FAS)- (06/04) Page: 1011 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 01/05/2009 1. Were regulatory violations issued during this visit? ~ Yes 0 No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? ~ Yes 0 No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 ~ No Yes ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this chiid care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: LA DAY CARE-EAST 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Paul Zaragosa Contact Person Telephone Number: (323) 219-5525 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC!I213 (FAS)· (1/04) STAT!! OF CALIFORNIA w HEALTH AND HUMAN SERVICES AGENCY APPLICANT/LICENSEE RIGHTS (Cont) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMStoN L.A. DAY CAREwfAST, 1000 CORPORATE CNTR DR. ,,... MONTEREY PARK. CA91754 Facility Name: BUNDLE OF JOY DAYCARE #3 Facility Number: 198007432 APPEAL PROCEDURES FOR APPLICANTS/LICENSEES One of your rights, as an applicant or licensee, is to file an appeal if you disagree w~h an action taken by the licensing agency. There are certain steps you must follow in order to ensure your concerns are heard. WHEN CAN YOU APPEAL? e If you disagree with a citation " If you have been assessed a civil penalty " If your application is denied or action is being taken to revoke your license WHAT ARE THE LEVELS OF APPEAL? Although there can be four levels of formal appeal of a licensing decision, you must start at the first level. This is to encourage review of your appeal as quickly as possible and to ensure that the decisions of licensing staff are reviewed by the appropriate supervisor. Any appeal made to the next level should include a clear explanation of what factor you feel was not adequately considered by the previous reviewer. Without an explanation provided by you the appeal review will be limited to the documents on which earlier decisions were based. Levels of appeal are as follows: 1. The Licensing Program Manager (LPM) or county equivalent 2. The Regional Manager (AM) 3. The Program Administrator (PA) 4. The Deputy Director, Community Care Licensing Division HOW AND WHEN DO YOU APPEAL? " If you disagree with a citation or penalty, file your appeal, with the Supervisor listed on the licensing report, in writing, within 10 days from the date you received the report or penalty assessment notice. " If you disagree with the decision made by the LPM, the second level of appeal must be made to the Regional Manager. The request for review must be made in writing after you receive the written decision from the LPM. • If you disagree with the decision made by the AM, the third level of appeal must be made to the PA. The request for review must be made in writing after you receive the decision made by the AM. • If you disagree with the decision made by the PA, the fourth level of appeal must be made to the Deputy Director. The request for review must be made in writing after you receive the decision made by the PA. • For denied application, follow the appeal instructions on the letter you were sent. For actions to suspend or revoke a license, follow the appeal instructions in the material served upon you by mail or in person. UC 9(158 w (FAS OB/O!i) Page: 2ar 2 STATE OF CAUFORNIAw HEALTH AND HUMAN SERVICES AGENCY APPLICANT/LICENSEE RIGHTS CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION LA. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 2011-B MONTEAEY PARK. CA91754 Facility Name: BUNDLE OF JOY DAYCARE #3 Facility Number: 198007432 Site Visit Rights 1. The right to require licensing field staff to identify themselves. 2. The right to be advised of the type of visit, whether annual site visit, complaint, plan of correction (POC), pre-licensing, or some other type. When a site visit is made to investigate a complaint, the site visit rights described in subsections (4} .and (9) shall be applicable at the completion of the investigation. 3. The right to be treated as a professional and with dignity and respect. 4. The right to receive an accurate report of the evaluator's findings listing each observed deficiency. Each deficiency shall be separately numbered, so as to clearly indicate the number of deficiencies, shall be accompanied by a number which corresponds to a section of law or licensing regulation, and shall include a description of the evaluator's observation which led to the finding of a deficiency. The description of the evaluator's observation shall include a clear explanation of why the existing condition constitutes a deficiency, unless the description of the observation provided such an explanation. 5. The right to review licensing laws, regulations and policy. 6. The right to an impartial investigation of all complaints. 7. The right, at the time of the visit, to determine and develop a plan of correction for deficiencies cited. 8. The right to use licensing reports as a means to agree or disagree with cited deficiencies. 9. The right to an extt interview upon completion of the visit and to receive a signed copy of the licensing report. 10. The right to be informed on the licensing report of the evaluator's supervisor and his/her telephone number. 11. The right to access to the public file on any facility and the right to purchase a copy at a reasonable cost. Initial Appeal Rights 1 . The right, wtthout prejudice, to appeal any decision, any failure to act according to law or regulation, or any failure to act within any specified time line, through the licensing agency up to the Deputy Director. Appeal procedures are on the following form. 2. The right to request a meeting with the Regional Manager to discuss any licensing issue and with notice to bring any person to the meeting. 3. The right to due process and the option of bringing a representative to any administrative action. 4. The right to file a formal complaint, and receive a written response to that complaint within 30 days, for any licensing issue not covered by the appeal rights listed above, including, but not limited to, inappropriate behavior of department employees. UC 905B. (FAS 00/05) Page: 1 01'2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNlA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) LA. DAY CARE-EAST, 100D CORPORATE CNTR DR. 201).8 MONTEREY PARK, CA 91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number TypaA 01/07/2009 Section Cited 101216.3(b) FACILITY NUMBER: 198007432 VISIT DATE: 01/05/2009 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 TEACHER-CHILD RATIO. LPA toured this 2 preschool program an observed 1 teacher, 1 3 qualified aide and 1 aide providing care for (18) 4 preschool children. This occurred between: 5 1:30 P.M.-2:00P.M. Ms. Stowe then arrived and 6 appropriate teacher-child ratios were restored. 1 Ucensee agrees to submit a plan in writing 2 ouUinlng what steps shall be taken to ensure that 3 this preschool program operates within the required 4 teacher - child ratio during hours of operation of 5 this preschool as this further ensures the Health 6 and Safety of children in care. 7 7 1 2 1 2 3 3 4 5 6 7 4 5 1 2 3 4 5 6 7 1 2 3 4 5 6 7 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: Knute Martin TELEPHONE: (323) 981-3365 UCENSING EVALUATOR NAME: Paul Zaragosa TELEPHONE: (323) 219-5525 UCENSING EVALUATOR SIGNATURE: 0~ ~{\ DATE: 01/05/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATNE SIGNATURE: DATE: 01/05/2009 This Notice must be posted for 30 days ....... (FAS)- (06/04) Page: 2 o12 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION FACILITY EVALUATION REPORT L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 20G-B MONTEREY PARK. CA 91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR:AYESHA AINSWORTH ADDRESS: 4835 LONG BEACH BLVD. CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: Case Management MET WITH: Yolanda Stowe FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: CENSUS:20 DATE: UNANNOUNCED TIME BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 01/05/2009 01:30PM 02:45PM NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A field visit made to this preschool today. Licensing Program Analyst Zaragoza met with Director, Yolanda Stowe. LPA toured the preschool, recorded staff names and observed teacher-child ratios. After a tour of this program, the following deficiency was observed in accordance with Title 22 Regulations for Child Care Centers as indicated on the page that follows. An exit interview was conducted and LPA also presented an Appeal Rights form (LIC 9058). 22 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul zaragosa TELEPHONE: (323) 219-5525 uc'"7~.r~~~r· DATE: 01/05/2009 1acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC80l> (FAS) - (06104) Page: 1 af2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 01/15/2009 1. Were regulatory violations issued during this visit? [:gi Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected {Type A)? [:gi Yes D No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) D [:gi No Yes ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: L.A. DAY CARE-EAST 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Paul Zaragosa Contact Person Telephone Number: {323) 219-5525 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 (FAS) • (1/04) STATE OF CAUFOANIA- HEAl.TH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE LICENSING OMSION: CIVIL PENALTV ASSESSMENT· IMMEDIATE LA. DAYCARE-EAST,1000CORPORATE CNTR DR.2il0-B MONTEREY PARK, CA 91764 FACILITY NAME DATE BUNDLE OF JOY DAYCARE #3 01/15/2009 FACILITY ADDRESS CITY 4835 LONG BEACH BLVD. LONG BEACH STATE ZIP CODE 90805 LICENSEE(S)/OPERATOFI . FACILITY NUMBER BUNDLE OF JOY DAY CARE INC. 198007432 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 parenVguardian notification and vlstl 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 volunteer without a criminal record clearance or exemption. Maximum 5 days for first violation. j:gJ $100 Immediate Civil Penalty per person for allowing any person (who Is subject to a background check) to work, reside or volunteer without a criminal record clearance or exemption. Maximum of 30 days for subsequent violations. 0 $100 immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before requesting a clearance transfer or before receiving approval of an exemption transfer. 0 $100 immediate Civil Penalty per parenVauthorlzed representative for failure to provide 'Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Exclusion)'. 0 $100 Immediate Civil Penalty per parenVauthorized representative for failure to provide "Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Reinstatement)'. D 0 D $100 immediate Civil Penalty per parenVauthorized representative for failure to obtain signature Indicating receipt of Addendum. $100 Immediate Civil Penalty for failure to provide signed addendum to the Department when requested. $100 Immediate Civil Penalty for failure to post the 'Notice of Site Visit Report" for 30 consecutive days. Individual #1 MICHAEL STOWE number of days 5 X $100 = $500.00 Penalty lndlvidual/12 number of days X $100 = $0.00 Penalty Individual #3 number of days X$100= $0.00 Penalty Total $500.00 YOU WILL RECEIVE A BILL IN THE MAIL DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Paul Zaragose "~·:r~rm= NAME OF FACILITY REPRESENTATIVE/TITLE YOLANDA STOWE SIGNATURE OF FACILITY REPRESENTATIVE SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 01/15/2009 TITLE UC421B (FAS)- (05/06) Page: 1 Of2 Control Number 33-CC-200901 07102423 STATE OF: CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCfAL SERV1CES COMMUNITY CARE LICENSING DMSKJN COMPLAINT INVESTIGATION REPORT (Cont) LA. DAYCARE·EAST, 1000 CORPORATE CNTR DR. 200.S MONTEREY PARK, CA 91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number Type A 01/16/2009 Section Cited 101170(e) FACILITY NUMBER: 198007432 VISIT DATE: 01/15/2009 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 7 CRIMINAL RECORD CLEARANCE. The van driver who transports children does not have a criminal record clearance and has been doing so for at leas five business days. 1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 5 6 7 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 5 6 7 5 6 7 Please make provisions to have this individual obtain a criminal record clearance an submit a plan to the Department outlining what steps shall be taken to ensure all adults obtaJn criminal record clearances prior their initial presence in the facility as this further ensures the Health and Safety to children receiving cere In the faciiHy. Failure to correct the cited deflclency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Paul Zaragosa UCA:o••~•"""'\J~ <>Are""""" I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: :,h~ N{Vf~ !llnwot LIC9099 (FAS) ~ {06104) DATE: 04/23/2014 Paga: 3of4 Control Number 33-CC-20140206084327 STATE CF CAUFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAl. SERVICES COMMUNITY CARE UCENSIHG DMSION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR OR. 200·8 MONTEREY PARK, CA91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number FACILITY NUMBER: 198007432 VISIT DATE: 04/23/2014 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type A 05/05/2014 Section Cited 1D1223(a)(2) 1 2 3 4 5 6 7 Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Child #1 was not accorded ssfety when child was allowed 1o play outside while it was wet, causing Injury to the lip. 1 2 3 4 5 6 7 When playground is found wet and/or slippery, with unsafe conditions; the facility shall redirect children to participate in indoor activities. Facility shall conduct all staff training for procedures on what to do when outdoor ac11vfty Is not an option. A copy shall be submitted to the Department no later than 05/05/2014. TypaA 04/07/2014 Section Cited 101 229(a)(1) 1 2 3 4 5 6 7 Care and Supervision. No child(ren)shali be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). Staff lacked observation of child #1, 1 2 3 4 5 6 7 Facility shall conduct a refresher training for providing Care & Supervision and observation of the child. A copy shall be submitted to the Department no later than 05/05/2014. as injury was not noticed by other staff until approximately 6 & half hours later. 1 2 1 2 3 4 5 6 7 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(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. TELEPHONE: (323) 981-3365 SUPERVISOR'S NAME: Bertha Manzanares LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: (323) 981-2949 LICENSING EVALUATOR SIGNATURE: ~ ·'i~"·y- DATE: 04/23/2014 !.acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 04/23/2014 This Notice must be posted for 30 days LIC9099 {FAS) • {05/04) Page: 2of4 Control Number 33-CC-20140206084327 STATE OF CAUFORNfA··HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. :ZOO..D MONTEREY PARK. CA 91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 FACILITY NUMBER: 198007432 VISIT DATE: 04/23/2014 NARRATIVE 1 2 3 4 5 Deficiencies are being cited in acccrdance to Title 22 of the California Code of Regulations and Health & Safety Codes. Please re1er to 9099D for documentation of deficiencies. An exit Interview was conducted with Assistant Director, Ms. Ashanti Murphy Bonman, appeal rights were explained. A Notices of Stte Visit and visit reports were posted this date. Advised all these documents must remain posted for 30 days to avoid cMI penalties of $100.00 from being issued. 6 The deficiencies are a direct violation that is noted in the Stipulation and Waiver and Order dated 10/18/12. 7 8 Upon receipt, licensee shall post and provide copies ofthis licensing report to parents/guardians of children in 9 I care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 10 'I months.* (LIC9224). 11 I 121 13 14 15 16 17 18 19 20 21 22 23 I 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: 323) 981-3365 LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: (323) 981-2949 LICENSING EVALUATOR SIGNATURE: 'J~ DATE: 04/23/2014 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~w:~S~~ UC9099 (FAS) ~ (08104) DATE: 04/23/2014 Pagl: 4 Of 4 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVJCESAGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR DR. 200..8 MONTEREY PARK, CA 91764 This is an official report of an unannounced visiVinvestigation of a complaint received In our office on 02/06/2014 and conducted by Evaluator Adriana Vasquez PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20140206084327 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR:ASHANTI MURPHY-BONMAN 4835 LONG BEACH BLVD. ADDRESS: CITY: LONG BEACH CAPACITY: 45 MET WITH: Ashanli Murphy-Bonman FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE: ZIP CODE: CENSUS: 32 DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198007432 650 (562) 728-6662 90605 04/23/2014 06:15AM 10:00AM ALLEGATION(S): 1 Personal Rights 2 3 4 5 6 7 6 9 INVESTIGATION FINDINGS: 1 Licensing Program Analyst (LPA), Adrtana Vasquez, conducted an unannounced site visit in order to issue 2 findings for the personal rights violation complaint received on 02/06/2014. It was alleged that child #1 received 3 a (non- medical emergency) injury on the lip, and the facility failed to contact parent #1 and document the 4 injury. LPA met with Assistant Director, Ashantl Murphy-Bonam. 5 6 7 8 9 10 11 12 13 Child #1 was allowed to play outside while it was wet from earlier rain and received the injury on the lip. It was witnessed by staff #1 however, it was not noticed or addressed by any of the other staff members throughout the remainder of the day. Staff also failed to document the injury. At the time of pick up, parent #1 was informed of the injury however, it was not documented until parent #1 insisted that the injury report be completed and signed by staff #1. Based on the information and documentation received, this complaint is substantiated. report continues on LIC9099C Substantiated SUPERVISOR'S NAME: Bertha Manzanares Estimated Days of Completion: TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: (323) 981-2949 LICENSING EVALUATOR SIGNATURE: ~'I~ DATE: 04/23/2014 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 04/23/2014 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9009 (FAS}- (06/04) Page: 1 of 4 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 04/23/2014 1. Were regulatory violations issued during this visit? ~ Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? ~ Yes D No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) ~ Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office. 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Adriana Vasquez Contact Person Telephone Number: (323) 981-2949 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 (FAS)- (1/04) STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Offlco, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 FACIUTYNUMBER: 198007432 VISIT DATE: 04/23/2014 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 221 231 Samples of children's records were reviewed & LPA observed Identification & Emergency information (LIC700) available and the Child's Health History (LIC702) available. Stafi records were reviewed & LPA observed the Health Screening (LIC503) available. CPR & First Aid for Teacher, Porsche Cooksies, is valid until 10/26/2014. Teacher to child ratios .were met during this site visit. Personnel Roster reviewed for background check clearances. Exit interview was conducted with Ashanti & Ashanti was infonned that, it is the responsibility of licensee & staff to know the regulations for Child Care Centers which can be accessed on-line at: www.ccld.ca.gov. There are no deficiencies baing cited during this Annuai/Requirsd site visit. Notice of site visit (LIC9213) must be posted for 30 consecutive days. Failure to post may result in a $100 civil penalty to be Issued. 241 25 26. 27 28 29 30 31 32 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981·3365 LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: (323) 981·2949 LICENSING EVALUATOR SIGNATURE: A~"!~ DATE: 04/23/2014 1 acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: . ~ H4~ ucoo• (FASI· (06104) 61 n{VQh\_ DATE: 04/23/2014 Page: 2 of2 STATE. OF CALIFORNIA- HEALTH AND HUMAN SERVtcESAGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION FACILITY EVALUATION REPORT CCLD Regional om c-o, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK. CA91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: YOLANDA STOWE ADDRESS: 4835 LONG BEACH BLVD. CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: Annual/Required MET WITH: Ashanti Murphy-Bonman 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 STATE:CA CENSUS:32 UNANNOUNCED FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198007432 850 {562) 728-6882 90805 04/23/2014 10:01 AM 12:30 PM NARRATIVE Licensing Program Analyst (LPA), Adriana Vasquez, conducted an unannouncad Annual/Required site visit, met with Lead Teacher, Ashanti Murphy Bonman, & together toured 1he facility. Upon arrival LPA observed 32 children & a total of 4 staff present. There are two preschool classrooms available. This is a full day preschool program bsginning at: 5:30am until 6:00pm & a second session from 6:00pm untii12:00am. LPA observed the License, Parenfs Rights & Personal Rights Poster's, Emergency Disaster Plan/Earthquake Preparedness Checklist, Food Menu & Child passenger Restraint System Poster, posted in a prominent area for review. Children receive breakfast, snacks lunch & dinner at the facility. Kitchen observed inaccessible to children. Kitchen was found clean and free of litter. Indoor drinking water dispenser was observed. Individual cubbies for children's belongings are available. Furniture & equipment were inspected for age appropriateness & good . repair. Cots are provided for naps. Children bring 1heir own linen & blanket then taken home every Friday, or as needed, to be laundered. First Aid kits are available. LPA did not observe medication on site however, Ashanti stated when medication is required it is maintained inaccessible to children, locked in the front office. Sinks & toilets met the required capacity for children & found clean. Front office used for isolation of a child. There is a cot and separate restroom available for an ill child. Fire Extinguisher is inspected annually; last Inspected & tagged on 1/14/14. The monthly emergency drill log is maintained In the front office & last drill on 2/27/14. Children are signed in by child's authorized representative with a pin code. Outdoor area has tree shade available & 2 water fountains to hydrate children. The outdoor equipment was inspected for safety, good repair & age appropriateness. Wood chips are used as cushioning material. LPA advised to have yellow colored wood rail either covered with cushioning material or removed as this may pose a danger in 1he future since the condition of~ is very old. LPA observed children's activities & staff interactions with children during this visit to ensure Health & Safety. There were no bodies of water observed during this visit. Ashanti stated there are no fire arms or weapons at the facility. 23 24 report continued on LIC809C 25 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Adriana Vaequez TELEPHONE: (323) 981-2949 ~:A~""\f~ DATE: 04/23/2014 1acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. DATE: 04/23/2014 This report must be available at Child Care and Group Home facilities for public review for 3 years. LJCBOO (FAS) • (0<104) Page: 1 ot2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 05/12/2014 1. Were regulatorY violations issued during this visit? 1:81 Yes 0 No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 1:81 Yes 0 No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 1:81 Yes 0 No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-8 MONTEREY PARK, CA 91754 Regional Office Contact Person: Michelle Carter Contact Person Telephone Number: (323) 896-6853 . THIS NOTICE MUST BE POSTED FOR 30 DAYS LlC9213 {FAS} ~ (1104) STATE OF CALIFORNIA- HEAlTH AND HUMAN SERVICES AGENCY APPLICANT/LICENSEE RIGHTS (Cont) CAUFORNIA DEPARTMErfl' OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVIStON CCL.D Regional Offico, 1000 CORPORATE Crfl'R DR. 200-B MONTEREY PARK, CA 91754 Facility Name: BUNDLE OF JOY DAYCARE #3 Facility Number: 198007432 APPEAL PROCEDURES FOR APPLICANTS/LICENSEES One of your rights, as an applicant or licensee, is to file an appeal if you disagree with an action taken by the licensing agency. There are certsin steps you must follow in order to ensure your concerns are heard. WHEN CAN YOU APPEAL? e If you disagree with a citation " If you have been assessed a civil penalty • If your application is denied or action is being taken to revoke your license WHAT ARE THE LEVELS OF APPEAL? Although there can be four levels of formal appeal of a lic_:ensing decision, you must start at the first level. This is to enccurage review of your appeal as quickly as possible and to ensure that the decisions of licensing staff are reviewed by the appropriate supervisor. Any appeal made to the next level should include a clear explanation of what factor you feel was not adequately considered by the previous reviewer. Without an explanation provided by you the appeal review will be limited to the documents on which earlier decisions were based. Levels of appeal are as follows: 1. The Licensing Program Manager (LPM) or ccunty equivalent 2. The Regional Manager (RM) 3. The Program Administrator (PA) 4. The Deputy Director, Community Care Licensing Division HOW AND WHEN DO YOU APPEAL? • If you disagree with a citation or penalty, file your appeal, with the Supervisor listed on the licensing report, in writing, within 10 days from the date you received the report or penalty assessment notice. • If you disagree with the decision made by the LPM, the second level of appeal must be made to the Regional Manager. The request for review must be made in writing after you receive the written decision from the LPM. • If you disagree with the decision made by the RM, the third level of appeal must be made to the PA. The request for review must be made in writing after you receive the decision made by the RM. • If you disagree with the decision made by the PA, the fourth level of appeal must be made to the Deputy Director. The request for review must be made in writing after you receive the decision made by the PA. " For denied application, follow the appeal instructions on the letter you were sent. For actions to suspend or revoke a license, follow the appeal instructions in the material served upon you by mail or in person. LIC !9058- (FAS 08/05) Page: 2 of 2 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY APPLICANT/LICENSEE RIGHTS CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE. UCENSING DMSION CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK. CA 91764 Facility Name: BUNDLE OF JOY DAYCARE #3 Facility Number: 198007432 Site Visit Rights 1. The right to require licensing field staff to identify themselves. 2. The right to be advised of the type of visit, whether annual site visit, complaint, plan of correction (POC), pre-licensing, or some other type. When a site visit is made to investigate a complaint, the site visit rights described in subsections (4) and (9) shall be applicable at the completion of the investigation. 3. The right to be treated as a professional and with dignity and respect. 4. The right to receive an accurate report of the evaluator's findings listing each observed deficiency. Each deficiency shall be separately numbered, so as to clearly indicate the number of deficiencies, shall be accompanied by a number which corresponds to a section of law or licensing regulation, and shall include a description of the evaluator's observation which led to the finding of a deficiency. The description of the evaluator's observation shall include a clear explanation of why the existing condition constitutes a deficiency, unless the description of the observation provided such an explanation. 5. The right to review licensing laws, regulations and policy. 6. The right to an impartial investigation of all complaints. 7. The right, at the time of the visit, to determine and develop a plan of correction for deficiencies cited. 8. The right to use licensing reports as a means to agree or disagree with cited deficiencies. 9. The right to an exit interview upon completion of the visit and to receive a signed copy of the licensing report. 10. The right to be informed on the licensing report of the evaluator's supervisor and his/her telephone number. 11. The right to access to the public file on any facility and the right to purchase a copy at a reasonable cost. Initial Appeal Rights 1. The right, without prejudice, to appeal any decision, any failure to act according to law or regulation, or any failure to act within any specrried time line, through the licensing agency up to the Deputy Director. Appeal procedures are on the following form. 2. The right to request a meeting with the Regional Manager to discuss any licensing issue and with notice to bring any person to the meeting. 3. The right to due process and the option of bringing a representative to any administrative action. 4. The right to file a formal complaint, and receive a written response to that complaint within 30 days, for any licensing issue not covered by the appeal rights listed above, including, but not limited to, inappropriate behavior of department employees. LIC 9NS£1 ~ (FAS 08/05) Paga: 1 of2 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont) CCLD R&glonal omce, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK. CA 91764 This is an official report of an unannounced visit/investigation of a complaint received in our office on 02/28/2014 and conducted by Evaluator Michelle Carter PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20140228165708 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: YOLANDA STOWE ADDRESS: 4835 LONG BEACH BLVD. CITY: LONG BEACH CAPACITY: 45 MET WITH: Ms. Ashanti Murphy-Bonman FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE: ZIP CODE: DATE: CENSUS: 36 UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 05/12/2014 09:30AM 11:30AM ALLEGATION(S): 1 Neglect/Lack of Supervision - Two Children were missing and found minutes later in School-age yard. 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA Carter arrived at the facility to deliver findings of complaint investigation. The complainant alleged that two 2 children were missing from the play ground and were found minutes later on the school-age yard. LPA 3 conducted interviews however there was no corroborating evidence to support this claim. The allegation is 4 determined inconclusive. 5 6 7 An exit interview was conducted and appeal rights were distributed. 8 9 10 11 12 13 Inconclusive SUPERVISOR'S NAME: Joan Hayes Estimated Days of Completion: TELEPHONE: (323) 981-3380 LICENSING EVALUATOR NAME: Michelle Carter TELEPHONE: (323) 896-6853 LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2014 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 'l6~~\f\P~e,7Jn~ DATE: 05/12/2014 This report must be available at Child Care and Group Home facilities for public review for 3 years. LJC9099 (FAS) ~ (06/04} Page: 3 of 4 Control Number 33-CC-20140228165708 STAT!!. OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSJNG OMS ION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Omce, 1000 CORPORATE CNTR DR. 2QO..B MONTEREY PARK, CA91764 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Numbur Type A 05/12/2014 Section Cited 101229 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 101229(a)(1) Care and Supervision. No chlld(ren) shall be left wilhoutthe supervision, Including visual observation, of a teacher at any time except as specified In secttons 101216.2(e)(1) and 101230(c)(1 ). 1 Ucensee will submtt a written play on actions to be 2 taken to prevent this type of incident from occurring 3 again. 4 5 6 7 a Based on information obtained from complaint investigation U was determined that at least 4 children were in the outdoor with their pants down. The faciley failed to provide adequate care and supervision. A civil penalty on $150 Is being assessed for absence of supervision. a 9 10 11 12 13 14 Type A 05i12/2014 Section Cited 101212 FACIUTYNUMBER: 198007432 VISIT DATE: 05/12/2014 1 2 3 4 5 6 7 9 10 11 12 13 14 101212(d) Reporting Requirements. A report shall 1 Ucensee shall submit a written statement on why be made to the Department within 24 hours of the 2 this was not reported to the department wtthln a 3 timely manner. occurrence of any unusual incident as specffied. 4 5 The incident which occurred above on or around 6 02/21/14 was not reported to the department. 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: Joan Hayes TELEPHONE: (323) 981-3380 LICENSING EVALUATOR NAME: Michelle Carter TELEPHONE: (323) 896-6853 LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2014 1 acknowledge receipt of this form and understand my appeal rights as explained and receivedFACILITY REPRESENTATIVE SIGNATURE: ~~~htA~bn~ DATE: 05/12/2014 This Notice must be posted for 30 days LIC9000(FAS)-(00!04) Page: 2 of4 STATE OFCALIFORNIAM HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE LICENSING DMSKlN COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-8 MONTEREY PARK, CA91764 This Is an official report of an unannounced visiVinvestlgatlon of a complaint received in our office on 02/28(2014 and conducted by Evaluator Michelle Carter PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20140228165708 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: YOLANDA STOWE ADDRESS: 4835 LONG BEACH BLVD. LONG BEACH CITY: CAPACITY: 45 MET WITH: Ms. Ashantl Murphy-Bonman FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE: ZIP CODE: DATE: CENSUS: 36 UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 05/12/2014 09:30AM 11:30AM ALLEGATION(S): 1 lack of Care and Supervision- 3to 4 children were unsupervised In the outdoor play area wah their pants 2 down. 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA Carter arrived at the facilay to deliver findings. The complaint alleged that children were unsupervised wah 2 their pants down. LPA Interviewed staff and all parties Involved. Based on Information obtained It was 3 confirmed that children were observed by a staff member In the outdoor are in the blue apparatus with their 4 pants down. 5 6 7 8 According to information obtained this Incident was reported to the head teacher however parents were not notified. This allegation Is being substantiated. The following deficiency is being cHad In accordance with lltle 22 and/ or Health and safety regulations of the State of CaiHomia. Please See LIC 9099D for cited deficiency. 9 10 Appeal rights were distributed and explained. An exit interview was conducted with Ms. Ashanti. 11 12 13 Estimated Days of Completion: Substantiated TELEPHONE: (323) 981-3380 SUPERVISOR'S NAME: Joan Hayes LICENSING EVALUATOR NAME: Michelle Carter TELEPHONE: (323) 896-6853 LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2014 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~In~ 81~~ DATE: 05/12/2014 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS)· (06/04) Pag&: 1 Of 4 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: BUNDLE OF JOY DAYCARE #3 198007432 ON 07/02/2014 1. Were regulatory violations issued during this visit? 0 Yes fXl No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 0 Yes fXl No 3. If regulatory violations were cited, could they become a risk to the heafih, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes fXl No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Adriana Vasquez Contact Person Telephone Number: (323) 981-2949 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 ifAS) - (1/04) STATE OF CALIFORNIA- HEALTH AND HUUAN SERVICES AGENCY APPLICANT/LICENSEE RIGHTS CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION CCLD Regional Office, 1000 CORPORATE CNTR DR. -· MONTEREY PARK, CA91754 Facility Name: BUNDLE OF JOY DAVCARE #3 Facility Number: 198007432 Site Visit Rights 1. The right to require licensing field staff to identify themselves. 2. The right to be advised of the type of visit, whether annual site visit, complaint, plan of correction (POC), pre-licensing, or some other type. When a site visit is made to investigate a complaint, the site visit rights described in subsections (4) and (9) shall be applicable at the completion of the investigation. 3. The right to be treated as a professional and with dignity and respect. 4. The right to receive an accurate report of the evaluator's findings listing each observed deficiency. Each deficiency shall be separately numbered, so as to clearly indicate the number of deficiencies, shall be accompanied by a number which corresponds to a section of law or licensing. regulation, and shall include a description of the evaluator's observation which led to the finding of a deficiency. The description of the evaluator's observation shall include a clear explanation of why the existing condition constitutes a deficiency, unless the description of the observation provided such an explanation. 5. The right to review licensing laws, regulations and policy. 6. The right to an impartial investigation of all complaints. 7. The right, at the time of the visit, to determine and develop a plan of correction for deficiencies cited. 8. The right to use licensing reports as a means to agree or disagree with cited deficiencies. 9. The right to an exit interview upon completion of the visit and to receive a signed copy of the licensing report. 10. The right to be informed on the licensing report of the evaluator's supervisor and his/her telephone number. 11. The right to access to the public file on any facility and the right to purchase a copy at a reasonable cost. Initial Appeal Rights 1. ·The right, without prejudice, to appeal any decision, any failure to act according to law or regulation, or any failure to act within any spectfied time line, through the licensing agency up to the Deputy Director. Appeal procedures are on the following form. 2. The right to request a meeting with the Regional Manager to discuss any licensing issue and with notice to bring any person to the meeting. 3. The right to due process and the option of bringing a representative to any administrative action. 4. The right to file a formal complaint, and receive a written response to that complaint within 30 days, for any licensing issue not coitered by the appeal rights listed above, including, but not limited to, inappropriate behavior of department employees. LIC 905S- (FAS 00/!15) Page: 1 or 2 STAlE! OF CAUFORNIA· HEALTH AtlD HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION FACILITY EVALUATION REPORT CCLD Ruglonal Offloo, 1000 CORPORATE CNTR DR. 2DO-B MONTEREY PARK, CA 91754 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: YOLANDA STOWE 4835 LONG BEACH BLVD. ADDRESS: CITY: LONG BEACH CAPACITY: 45 TYPE OF VISIT: Case Management Yolanda Stowe MET WITH: 1 2 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE:CA ZIP CODE: DATE: CENSUS: 23 UNANNOUNCED TIME BEGAN: TIME COMPLETED: 196007432 850 (562) 728-6882 90605 07/02/2014 06:40AM 09:30AM NARRATIVE Ucensing Program Analyst (LPA) Adriana Vasquez conducted an unannounced case management visit. LPA met with Director, Yolanda Stowe and discussed the nature of the visit. 3 4 5 LPA arrived to the facility to obtain statements from preschool teachers that were present in regards to the complaint received on 05/13/2014. LPA spoke to Teacher #1 & Teacher #2. Statements were obtained. 6 7 8 The Notice of Site Visit (LIC 9213) was issued and posted during this visit.- Notice must remain posted for 30 9 days during the hours of operation after each site visit by a licensing representative. Failure to maintain 10 posting as required will result in a civil penalty of $100.00. 11 12 Exit interview conducted. There were no deficiencies cited during today's visit. 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 961 -3365 LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: (323) 981-2949 LICENSING EVALUATOR SIGNATURE: cA J~aN,~) · \\,j (}J~A~{~ DATE: 07/02/2014 I acknowledge receipt of this fonm and understand my licensing appeal rlghta as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2014 This report must be available at Child Care and Group Home facilities for public review for 3 years. LICOO!I (FA$)· (06Jil4) Pave: 1 of1 Control Number 33-CC-20140513160830 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DNISJON COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91764 FACIUTY NAME: BUNDLE OF JOY DAYCARE #3 FACILITY NUMBER: 198007432 VISIT DATE: 07/02/2014 NARRATIVE 1 Witness #1 stated the following was observed: While parking on the side street of the facility, witness #1 saw 2 a child alone in the play yard, trying to open the door to the preschool classroom. This lasted for 3 approximately 3-5 minutes. When witness 111 entered the facility, she saw a steff member open the door to 4 the preschool classroom and allowed that same child inside. 5 6 LPA inspected the play yard area and the side street parking of the facility. LPA determined that while sitting In a vehicle and looking into the play yard, the play yard was not clearly visible due to the heavy blue mesh 7 8 covering the play yard fence. LPA was not able to see through the blue mesh unless the LPA was standing 9 near the fence and nearly pressing the face on the mesh in order to see through it. 10 11 During interviews with children LPA was not able to get consistent statements from the children whether or not 12 they have been left alone during time out. Staff statements are consistent with following the facilities time out 13 policy. 14 15 Based off of the information obtained throughout the course of the complaint investigation, there is insufficient 16 evidence to prove complaint allegations, therefore complaint allegations are inconclusive. 17 18 Exit interview conducted. There were no deficiencies cited during this visit 19 20 The Notice of Site Visit (LIC 9213)- must remain posted for 30 days during the hours of operation after each 21 site visit. Failure to maintain posting as required will result in a civil penalty of $100.00. 22 23 24 25 26 27 28 29 30 i 31 I 32 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: (323) 981-2949 LICENSING EVALUATOR SIGNATURE: Jc\J~~) "\\~,£ DATE: 07/02/2014 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2014 CIC .... (FAS) • (06/04) Page: 2of2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLD Raglonal omca, 1000 CORPORATE CNTR DR. 200·B MONTEREY PARK, CA 91764 This is an official report of an unannounced visiVinvestigation of a complaint received in ·our office on 05/13/2014 and conducted by Evaluator Adriana Vasquez PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20140513160830 FACILITY NAME: BUNDLE OF JOY DAYCARE #3 ADMINISTRATOR: YOLANDA STOWE ADDRESS: 4835 LONG BEACH BLVD. CITY: LONG BEACH CAPACITY: 45 MET WITH: Yolanda Stowe FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE: ZIP CODE: CENSUS: 23 DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198007432 850 (562) 728-6882 90805 07/02/2014 09:31AM 11:00AM ALLEGATION($): 1 Personal Rights 2 Lack of Supervision 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 *"THIS REPORT REPLACES THE LIC9099 REPORT DATED 05/16/2014.. 2 3 Licensing Program Analyst (LPA), Adriana Vasquez, conducted an unannounced sne visit and met with 4 Director, Yolanda Stowe, in order to issue findings for the personal rights and lack of supervision violation 5 complaint received on, 05/13/2014. It was alleged that children are left alone during 'time out' and that a child 6 was left outside in the play yard unsupervised, until a teacher opened the classroom door to allow the child in, 7 approximately 3-5 minutes later. 6 9 LPA Interviewed parent #1 and witness #1 and obtained the following information: Parent #1 stated her child 10 has disclosed on two separate occasions that the child was left alone while being placed on time out; once · 11 outside in the play yard and once alone in the office with another child who was also placed on time out at the 12 same time. Re or! continues on LIC9099C 13 Estimated Bertha Manzanares TELEPHONE: {323) 981-3365 LICENSING EVALUATOR NAME: Adriana Vasquez TELEPHONE: {323) 981-2949 ~A~'\\~ DA>E"-" I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2014 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC~9 (FAS) ~ (06104) Page: 1 of 2 DELEGATION 1. 2. I hereby delegate to JoAnn Hirai, as Chief of Investigations Branch, John Rodriquez, as Chief of Continuing Care Contracts Branch, Gloria Merk, as Program Administrator of Child Care Program, Mary Jolts as Program Administrator of Adult and Senior Care Program, Kathi Mowers-Moore, as Chief of the Central Operations Branch; my p·ower to issue the following administrative pleadings under the Administrative Procedure Act, Government Code Section 11500 et seq.: (a) Accusations and orders for temporary license suspension prior to hearing, pursuant to Health and Safety Code Sections 1550, 1550.5, 1568.082, 1569.50,1569.51,1569.885, or 1596.886. (b) Statements of issues pursuant to Health and Safety ·code Sections 1526, 1568.063, 1569.22, or 1596.879. (c) Orders to require that an employee. or prospective employee of a facility not work or be present in a facility pending a final decision of the matter, pursuant to Health and Safety Code Sections 1558, 1568.066, 1569.58, or 1596.8897. They may exercise this power when, in their opinion, the action is necessary to protect the residents or clients from physical or mental abuse, abandonment, or any other substantial threat to the health and safety of the residents or clients. These delegations are made pursuant to Government Code Section 7. They shall remain in. effect until explicitly revoked. WILL L!GHTBOURNE Director California Department of Social Services 1 30. The facts alleged in paragraphs 14(A), 14(C) and 23, individually and/or 2 jointly, provide cause, pursuant to Health and Safety Code section 1596.8897 to prohibit 3 Respondent Edward Stowe's employment in, presence in, ·and contact with clients of 4 any facility licensed by the Department. 5 31. The facts alleged in paragraphs 14(A), 14(C) and 23, individually and/or 6 jointly, constitute conduct by Respondent Edward Stowe which is inimical to the health, 7 safety, morals or welfare of clients receiving care from the facility, or to the people of the 8 State of California. These facts provide cause, pursuant to Health and Safety Code 9 sections 1596.885(c) and 1596.8897(a)(2), to prohibit Respondent Edward Stowe's employment in, presence in, and contact with clients of any facility licensed by the 10 11 j! PETITION FOR RELIEF 12 13 14 15 Department. 32. WHEREFORE, complainant requests that Respondent Bundle of Joy I i Day Care !nc.'s licenses to operate a child day care center be revoked. 33. WHEREFORE, complainant requests that Respondent Edward Stowe 16 be prohibited for the remainder of Respondent's life, from employment in, presence in, 17 and contact with clients of any facility licensed by the Department and from being a 18 member of the board of directors, an executive director, or an officer of a licensee of 19 any facility licensed by the Department. DATED: June 1, 2012 20 21 / 22 JEFFREY Deputy Dlr ct Community Care Licensing Division California Department of Social Services 23 24 25 26 27 , Sundle of Joy (Edward Stowe)-accusation and exclusion.doc i 9 24. Licensee engaged in conduct that is inimical to the health, morals, 1 2 , welfare, or safety of either an individual in or receiving services from the facility, or the 3 people of the State of California as alleged in paragraphs 14 through 22, above, and 4 incorporated here by reference. CAUSE FOR LICENSE REVOCATION AND ORDER OF EXCLUSION 5 6 25. The facts alleged in paragraphs 14 through 15, 18 through 19, and 22 7 through 24, individually and/or jointly, provide cause, pursuant to Health and Safety · 8 Code section 1596.885(a)-(d) to revoke Respondent Bundle of Joy Day Care Inc.'s 9 license to operate Facility No. 1. 26. 10 The facts alleged in paragraphs 14, 18 through 19, and 22 through 24, 11 individually and/or jointly, provide cause, pursuant to Health arid Safety Code section 12 1596.885(a)-(d) to revoke Respondent Bundle of Joy Day Care Inc.'s license to 13 operate Facility No. 2. 27. The facts alleged in paragraphs 16 through 17, 20, 22 and 24, 14 15 individually and/or jointly, provide cause, pursuant to Health and Safety Code section 16 1596.885(a)-(d) to revoke Respondent Bundle of Joy Day Care Inc.'s license to 17 operate Facility No. 3. 18 28. The facts alleged in paragraphs 17, 21, 22 and 24, Individually and/or 19 jointly, provide cause, pursuant to Health and Safety Code section 1596.885(a)-(d) to 2o revoke Respondent Bundle of Joy Day Care Inc.'s license to operate Facility No. 4. 21 29. The facts alfeged in paragraphs 14 through 24, individually and/or jointly, 22 constitute conduct by Respondent Bundle of Joy Day Care Inc. which is inimical to the 23 health, safety, morals or welfare of clients receiving care from the facility, or to the 24 people of the State of California. These facts provide cause, pursuant to Health and 25 Safety Code sections 1596.885(c) and 1596.8897(a)(2), to revoke the license to opera! 26 the facility. 27 II II Bundle of Joy (Edward Slowa)·accusation and excluslon.doc 8 21. Licensee violated regulations regarding criminal record clearances in the 1 operation of Facility No. 4 as follows: 2 A. From approximately February 2010 until July 2, 2010, licensee failed to 3 4 have teacher, Miracle Butler, associated to the facility. B. Fr~m approximately February 2, 2009 until August 25, 2009, licensee 5 failed to have facility director, Cynthia Manjarrez, associated to the facility. 6 C. From approximately January 26, 2009 until January 28, 2009, licensee 7 8 had teacher Valda L. Dowd-Daniels, an individual without a criminal record 9 clearance, provide care and supervision to children in care. D. On August 12, 2008, and for an unknown period prior to that date, 10 11 licensee failed to have teacher's aide, Alexis Jones, associated to the facility and 12 her criminal record clearance on file. UBJECT MATTER: 13 FALSE AND/OR MISLEADING STATEMENTS/CONDUCT INIMICAL 14 APPLICABLE LAW: 15 Health and Safety Code sections 1596.885(c) and 16 1596.8897(a)(2) 17 Regulation section 101163 ALLEGATIONS: 18 19 22. On various occasions between November 30, 2005 and March 8, 2010, 20 Licensee submitted documents to the Department which indicated Ayesha Ainsworth 21 was employed as the Director for Facilities No.1 and 2. 23. Respondent Stowe engaged In conduct that is inimical to the health, 22 23 morals, welfare, or safety of either an individual in or receiving services from the facility, 24 or the people of the State of California as alleged in paragraphs 14(A) and (C). 25 II 26 II 27 !I Bundle of Joy (Edward Stowe )-accusation and excluslon.doc 1 7 A. On January 15, 2009, and for an unknown period prior to that date, 1 2 licensee had Michael Stowe, an individual without a criminal record clearance, 3 transport children in care. As a factor in aggravation, on December 5, 2008, the Department 4 5 conducted an informal meeting with licensee to discuss the history of 6 deficiencies, which included prior criminal record clearance citations of 7 November 6, 2008, May 23, 2006, and January 24, 2005. B. On November 6, 2008, and for an unknown period prior to that date, 8 Licensee failed to associate staff acting as a substitute teacher to children in 9 care. 10 19. Licensee violated regulations in the operation of Facility No. 1 and 2 as ll 12 follows: A. Licensee violated reporting regulations by failing to submit a written 13 14 report to the Department regarding the incident alleged in paragraphs 14(A)- 15 14(8) within seven days following the occurrence of such event. 16 B. Licensee violated reporting regulations by failing to notify the 17 Department that Ayesha Ainsworth was not employed as the child care center 18 director as previously indicated. 20. Licensee violated regulations regarding criminal record clearances in the 19 operation of Facility No.3 as follows: 20 A. On August 12, 2008, and for an unknown period prior to that date, 21 22 licensee had teacher aide Adrienne Rice, an individual without a criminal record 23 clearance, provide care and supervision to children in care. B. On October 15, 2008, and for an unknown period prior to that date, 24 licensee failed to have two staff members associated to the facility. 25 26 if 27 // I Bundle of Joy (Edward Stowe)-eccusation and exclusion .doc 6 16. Licensee violated the personal rights of children in care of Facility No. 3 1 as follows: 2 A. On at feast one occasion prior to September 23, 2009, licensee failed 3 4 to adequately supervise children in care resulting in a child iri care biting another 5 child in care. B. On or about July 9, 2009, licensee failed to adequately supervise 6 7 children in care resulting In one infant falling on top of another infant and biting 8 her on the head. 17. Licensee failed to maintain teacher child ratios at Facility No. 3 and 4 as 9 follows: 10 11 B. On July 22, 2009, and for unknown periods prior to that date, one teacher was alone with five infants. 12 As a factor in aggravation, Licensee had been cited on November 5, 13 14 2008, for operating in violation of teacher child ratios for periods prior to 15 November 4, 2008, and assessed civil penalties for continuing to operate in 16 violation of ratios during the November 13, 2008, plan of correction visit. As additional factors in aggravation, licensee had also been cited 17 18 !i on October 15, 2008 and August 14, 2008 for operating in violation of teacher child ratios. 19 20 SUBJECT MATTER: VIOLATIONS 21 22 APPLICABLE LAW: Health and Safety Code sections 1596.871 and 1596.885Regulation section 101170,101212 23 24 CRIMINAL RECORD CLEARANCES/REPORTING ALLEGATIONS: 18. licensee violated regulations regarding criminal record clearances in the 25 26 operation of Facility 1 and 2, as follows: 27 !I Bundle of Joy (Edward Stowe)·accusatlon and excluslon.doc 5 1 in or contact with clients of a child day care center, is subject to the jurisdictional 2 provisions of Health and Safety Code sections 1596.871 and 1596.8897. Copies of the 3 applicable statutes and regulations accompany this Accusation as ATTACHMENT E 4 and are incorporated by reference. sj FACTUAL ALLEGATIONS t 6 SUBJECT MATTER: PERSONAL RIGHTS VIOLATIONS/LACK OF CARE AND 7 SUPERVISION/ TEACHER CHILD RATIO/REPORTING 8 VIOLATIONS 9 APPLICABLE LAW: Health and Safety Code sections 1596.885 and 1596.8897 10 Regulation sections 101416.5, 101417, 101223, 101225, 11 101229 12 ALLEGATIONS: 14. Licensee violated the personal rights of children in care of Facility No. 1 13 14 and 2 as follows: is 16 A. On or about February 15, 2012, Respondent Stowe left Child No.1, a client of Facility No. 1, in a van for approximately one and a half hours. B. On or about February 15, 2012, Licensee was unaware that Child No. 17 18 1's whereabouts. C. On occasions prior to February 15, 2012, Licensee and Respondent 19 20 Stowe failed to ensure that children in care were secured in an appropriate 21 restraint system when being transported. 15. Licensee failed to maintain teacher child ratios at Facility No. 1 as 22 23 24 25 26 27 follows: A. On October 16, 2008, and for unknown periods prior to that date, one teacher was left to supervise 1.8 children. As a factor in aggravation, licensee had been cited on January 26, 2005, for leaving one aide alone to supervise 10 children. Bundle of Joy (Edward Stowe)-accusatlon and excluslon.doc 4 1 8. Pursuant to Health and Safety Code sections1596.887(b), 1596.889, 2 and i596.8897(e), the standard of proof to be applied in this proceeding is the 3 preponderance of evidence. THE PARTIES 4 5 9. Complainant JEFFREY HIRATSUKA is the Deputy Director of the 6 Community Care Licensing Division of the Department. Pursuant to Government Code 7 section 11503, complainant files this Accusation in his official capacity. 8 10. Respondent BUNDLE OF JOY DAY CARE INC. ("Licensee") is licensed 9 by the Department to operate a child day care center for preschool children (Facility No. 10 1) and a child day care center for school age children (Facility No.2) at 4835 Long 11 Beach Boulevard, Long Beach, California 90805 ("Bundle of Joy Daycare #3"). These 12 facilities were initially licensed on June 3, 2002. A copy of Facility No. 1 and Facility No. 13 2's licenses setting forth the capacity, limitations, and effective dates accompany this u i Accusation respectively as ATTACHMENT A and ATTACHMENT Band are Incorporated by reference. 15 11. Respondent EDWARD STOWE ("Respondent Stowe") is employed by 16 and/ or has contact with the clients of Respondent Bundle of Joy Day Care Inc. 17 12. Licensee is also licensed by the Department to operate a child day care 18 19 center for infants (Facility No. 3) and a child day care center for preschool children 20 (Facility No.4) at 3588-90 Long Beach Boulevard, Long Beach, California 90807 21 ("Bundle of Joy Daycare #4"). These facilities were initially licensed on October 27, 22 2004. A copy of Facility No.3 and Facility No. 4's licenses setting forth the capacity, 23 limitations, and effective dates accompany this Accusation respectively as 24 ATTACHMENT C and ATTACHMENT D and are incorporated by reference. 13. Respondent Bundle of Joy Day Care Inc., by virtue of licensure, must 25 26 operate in accordance with the statutes and regulations governing the licensing and 27 operation of child day care centers. Respondent Edward Stowe, by virtue of presence I Bundle of Joy (Edward Stowe)-<>CCI.lsation and excluslon.doc 3 JURISDICTION 1 2 I 1. This matter arises under the California Child Day Care Facilities Act, 3 Health and Safety Code section 1596.70 et seq., which governs the licensing and 4 operation of child day care centers. 2. 5 The regulations which govern the licensing and operation of child day 6 care centers are contained in California Code of Regulations, title 22, section 101151 et 7 seq. 1 3. 8 9 J.o The California Department of Social Services ("Departmenf') is the agency of the State of California responsible for the licensing and inspection of child da care centers. 4. 11 The Department may prohibit a licensee from employing, continuing the 12 employment of, allowing in, or allowing contact with clients of a licensed facility by any 13 employee, prospective employee, or other person who is not a client of a child day care 14 center pursuant to Health and Safety Code section 1596.8897. 5. 15 Administrative proceedings before the Department must be conducted in 16 conformity with the provisions of the California Administrative Procedure Act, Chapter 5, 17 Government Code section 11500 et seq. 6. 18 Pursuant to Health and Safety Code section 1596.8897(f), the l9 Department may institute or continue a disciplinary proceeding against a person 2o following the resignation, withdrawal of employment application, or change of duties, or 2l any discharge, failure to hire, or reassignment of the person by the licensee or if the 22 person no longer has contact with clients of the facility. 7. 23 Pursuant to Health and Safety Code section 1596.854, the Department 24 may institute or continue a disciplinary proceeding against a licensee following the 25 suspension, expiration, or forfeiture of a license. 26 II 27 Subsequent references to any regulation sec:tlon(s} are to Title 22 of the California Coda of Regulations. Bundle of Joy (Edward Stowe}-accusatlon and exclusion .doc 2 1 1 1LEGAL DIVISION Department of Social Services 2 1 Office of General Counsel SHIRLEY D. RAMIREZ 3 Assistant Chief Counsel NANA CHIN, State Bar No. 224690 4 Senior Staff Attorney 1000 Corporate Center Drive, Suite 670 5 Monterey Park, CA 91754 Telephone Number: (323) 980-4898 6 Facsimile Number: (323) 981-3433 7 Attorneys for Complainant BEFORE THE DEPARTMENT OF SOCIAL SERVICES STATE OF CALIFORNIA 8 9 10 IN THE MATTER OF: 11 12 BUNDLE OF JOY DAY CARE INC. dba Bundle of Joy Daycare #3 3785 Rafferty Circle Corona, California 90805 CDSS No. 6212074103 OAH No. EDWARD STOWE CDSS No. 62120741038 ACCUSATION (LICENSE REVOCATION) 13 14 15 ACCUSATION (EXCLUSION ACTION) 16 17 BUNDLE OF JOY DAY CARE INC. dba Bundle of Joy Daycare #3 3785 Rafferty Circle Corona, California 90805 18 19 ACCUSATION (EXCLUSION ACTION) BUNDLE OF JOY DAY CARE INC. dba Bundle of Joy Daycare #4 3588-90 Long Beach Boulevard Long Beach, California 90807 20 21 22 CDSS No. 6212074103E ACCUSATION (LICENSE REVOCATION) BUNDLEOF JOY DAY CARE INC. dba Bundle of Joy Daycare #4 · 3588-90 Long Beach Boulevard Long Beach, California 90807 23 24 s 25 26 CDSS No. 6212074103C CDSS No. 6212074103H ACCUSATION (LICENSE REVOCATION) ts. II 27 ·If Bundle of Joy (Edward Stowe)-accusation and exclusion .doc 1 1 DECISION AND ORDER 2 The preceding Stipulation hereby is adopted by the· Department as its Decision in this. matter. DAY OF october IT IS SO ORDERED THIS ., Bth € '] B 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 revocation stayed with probatlon.docx 11 • 2012. I I :I <. 19. EFFECTIVE DATE: This Stipulation is effective on the date on which the Department's Order adopting it is executed. 20. 41 NO ORAL MODIFICATION: This Stipulation constitutes the entire agreement between the parties with respect to the Accusation in this ~se. Moreover. 5 ; the terms of this Stipulation cannot be amended except in writing, signed by all the € J parties thereto. IT IS SO STIPULATED: 7 i 8 c i 10 DAI ED Yolanda Stowe for Respondent Bundle of Joy Inc. DATED Edward Stowe Respondent 11 I 12 ' 13 14 1!5 I I ~ 1·6 1 17 18 :i ~~~------------DATED ! Janice Mendel Attorney for Respondents I I 19 i 20 DA+foY/ 20 12.~-- 21 Senior Staff Counsel Attorney for Complainant 22 23 24 I r>(-yJ Uj 1.:__ - -~ •DATED 25 26 F. Y HIRATSUKA, Complainant uty Director Community Care Licensing Division Department of Social Services State of California 27 Irevocation stayed with proballon.docx 10 SEP-21-2012 14:56 T0:13239813433 FROM:MESS1NA Ll=ILAFARIAN M 818 242 4828 T0•91818C Lti n .1.1:1 .A ~,u..i/. ..?OI..t. I ! !9 :.10 21 OA"L"ED "~.c~------------------~ S!!nior S'tff Counsel Attorney'( Ccmpleinant a 7. ;l ~1 1 tiA"TEO i!5 i6 , '/ ""'""oliun slllye!S with probat!Otl docx 10 1 13. WAIVER OF HEARING RIGHTS: The parties waive their rights to a 2 hearing in this matter, to present any evidence on their behalf and to cross-examine 3 witnesses testifying on the other party's behalf. The parties further waive their rights to ~ further discovery in this matter. 5 6 I 14.- WAIVER OF APPEAUMODIFICATION RIGHTS: Respondents waive all rights of review arising out of this action or this Stipulation or the Order Implementing )I 1 . it, including but not limited to a petition for reinstatement, reduction of penalty, or I 8 .1 rehearing, writ of administrative mandamus, any other judicial or administrative review s or any other right or ability they may have to seek to have this agreement modified or set aside ori any grounds whatsoever. 1C 11 15. WAIVER OF CLAIMS: The parties waive all known or unknown legal 12 actions or claims against each other, or their employees or agents, that they may have 13 acquired or come to acquire arising out of this matter, with the following_ exceptions: 14 A. Civil penalties; .15 B. Monitoring fees; and 1€ C. Any action arising out of an audit or other review to establish, 17 modify, preserve, enforce, or to recover an overpayment or to reimburse an 18 underpayment of public or private funds. 19 16. PUBLIC RECORD: This Stipulation is a public record as required by 20 section 11517(d) of the Government Code. It Is accessible to the public pursuant to the 21 Public Records Act, section 6250 et ~-of the Government Code. 22 17. SIGNATURES: A facsimile or seen ned copy ofthe signature page of 23 24 25 this Stipulation will bind the signing party or parties to the terms and conditions herein I once any remaining party or parties execute the document and once the Order-is executed. 26 ! 27 1// II 18. COUNTERPARTS: This Stipulation may be executed in counterparts. revocation stayed with probatlon.docx 9 10: COMPLETION OF PROBATION (Respondent Edward Stowe): If 2 Respondent Edward Stowe has successfully complied with the terms-of the Stipulation, 3 at the end of thiriy (30) months from the effective date of this Stipulation, probation shall expire ~nd the exclusion imposed upon Respondent Edward Stowe by this Stipulation shall be vacated. 11. DEPARTMENT'S ~UTHORITY: The fact that the Department may 7 decll_ne or omit to take Immediate disciplinary action for a violation of a condition of e .probation or any of the otber terms of this Stipulation does not constitute a waiver by the 9 Department of the. right to raise that violation at a later date in a disciplinary proceeding 1c or in any other context. Respondents understand that nothing in this Stipulation is to be 11 construed to .limit the authority of the Department to impose discipline for violations of 12 statutes and regulations applicable to Respondents. If any accusation seeking to revoke Respondent Bundle of Joy Inc.'s 13 14 probation Is filed by the Department during the period of probation, then the period of 15 probation and the probationary terms shall be extended, If necessary, beyond thirty 16 (30) months and shall remain in force and effect until such time as the Department ·1 7 issues a final Decision and Order on the accusation. If any accusation seeking to vacate the stay is filed by the Department agains 18 19 Respondent Edward Stowe during the period of probation, then the period of probation 20 shall be extended, if necessary, beyond thirty (30) months and shall remain in force 21 and effect until such time as the Department issues a final Decision and Order on the 22 · accusation. 23 12. MONITORING FEE