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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
GSIU-BBZSHQ

FACILITY NAME
Langley Meadows Community Association Out of School Program
SERVICE TYPES
305 Group Child Care (School Age)
FACILITY LICENSE #
0782697
FACILITY ADDRESS
2244 Willoughby Way
FACILITY PHONE
(604) 308-8851
CITY
Langley
POSTAL CODE
V2Y 1C1
MANAGER
Joanne Robinson/Erin Yachuk

INSPECTION DATE
May 03, 2019
ADDITIONAL INSP. DATE (multi-day)
May 09, 2019
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
3.5
ARRIVAL
09:00 AM
DEPARTURE
11:00 AM
ARRIVAL
02:00 PM
DEPARTURE
03:30 PM
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# OBSERVED IN CARE
18

Introduction

An unscheduled routine inspection was conducted to assess compliance with the Community Care and Assisted Living Act (CCALA), the Child Care Licensing Regulations (CCLR) and the relevant Director of Licensing Standards of Practice (DLSP). All areas of the facility were inspected for compliance.

Contraventions
Previous Inspection -
Current Inspection - Items reviewed comply with the Act, regulations & standards of practice except for those noted on supplementary pages.

Observed Violations
STAFFING: 12040 - CCLR s.19(1)(a) - A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has first met with the person and obtained all of the following: (a) a criminal record check for the person.
Observation: Review of 4 staff files observed that one staff has a copy of criminal records clearance (CRC) but it is not site specific. Other 3 staff were missing CRC on file.Licensing noted that staff CRC applications were faxed to CRC agency Victoria on May 07, 2019.
Corrective Action(s): Ensure to obtain copies of staff CRC prior to start of their employment.
Date to be Corrected: CRC applications submitted on May 07

STAFFING: 12050 - CCLR s.19(1)(b) - A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has first met with the person and obtained all of the following: (b) character references in respect of the person.
Observation: Review of all 4 staff files observed manager is missing one copy of reference and two staff have a list of names and phone numbers for reference but there is no evidence of verification of the references.
Corrective Action(s): Ensure staff files are complete.
Date to be Corrected: May 13, 2019

STAFFING: 12070 - CCLR s.19(1)(d) - A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has first met with the person and obtained all of the following: (d) copies of any diplomas, certificates or other evidence of the person's training and skills.
Observation: Review of 4 staff files observed 2 staff were missing evidence of ECE or RI training on their file.
Corrective Action(s): Ensure staff files are complete.
Date to be Corrected: May 13, 2019

STAFFING: 12090 - CCLR s.19(1)(f) - A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has first met with the person and obtained all of the following: (f) evidence that the person has complied with the Province's immunization and tuberculosis control programs.
Observation: Review of staff files observed one staff was missing copy of immunization status.
Corrective Action(s): Ensure staff files are complete
Date to be Corrected: Corrected before the second day inspection

POLICIES AND PROCEDURES: 13020 - CCLR s.22(1)(b) - A licensee must have all of the following: (b) an emergency plan that sets out procedures to prepare for, mitigate, respond to and recover from any emergency.
Observation: Fire extinguisher was missing certification tag.
Corrective Action(s): Please ensure to comply the emergency response plan including a valid fire extinguisher.
Date to be Corrected: May 10, 2019

MEDICATION: 16080 - CCALA s.7(1)(b)(i) - A licensee must do all of the following: (b) operate the community care facility in a manner that will promote (i) the health, safety and dignity of persons in care,
Observation: Review of first aid supplies found an expired medication in the first aid bag.
Corrective Action(s): Please ensure the practices that promote the health and safety of children in care.
Date to be Corrected: Corrected during the inspection

RECORDS AND REPORTING: 19070 - CCLR s.57(2)(a) - A licensee must keep, for each child, a record showing the following information: (a) name, sex, date of birth, medical insurance plan number and immunization status.
Observation: Review of 7 children files observed two children were missing immunization status on file.
Corrective Action(s): Ensure children files are complete
Date to be Corrected: May 13,2 019

RECORDS AND REPORTING: 19080 - CCLR s.57(2)(b) - A licensee must keep, for each child, a record showing the following information: (b) date of enrolment in the community care facility.
Observation: Review of 7 children files observed one child was missing date of enrollment on file.
Corrective Action(s): Ensure children files are complete.
Date to be Corrected: May 13, 2019


Comments

This inspection was a multiple day inspection. At the inspection dated May 03, 2019 there were 13 children and 2 staff present. On May 09, 2019, there were 18 children and 2 staff working with children. At this inspection the above noted contraventions were identified. As part of this Routine Inspection a Facility Risk Assessment Tool is completed and a copy is provided.
A written response is requested from the manager outlining their plan to correct the contravention by the dates provided in the inspection report.

Action Required by Licensee/ManagerAction Required by Licensing Staff
Take corrective action to bring facility into complianceNo action required

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