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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
CGEE-AX9V38

FACILITY NAME
Variety Children's Centre, Cariboo
SERVICE TYPES
301 Group Child Care (under 36 months)
302 Group Child Care (30 months to school age)
FACILITY LICENSE #
NGIL-ANGPAA
FACILITY ADDRESS
7200 Cariboo Rd
FACILITY PHONE
(604)
CITY
Burnaby
POSTAL CODE
V3N 4A7
MANAGER
Lesley Cannon

INSPECTION DATE
March 27, 2018
ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
2
ARRIVAL
03:00 PM
DEPARTURE
05:00 PM
ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# CHILDREN ENROLLED
33

Introduction

An unscheduled routine inspection of this community care facility (CCF) was conducted by the licensing officer (FHA) to assess compliance w/ the:
• Community Care & Assisted Living Act (CCALA)
• Child Care Licensing Regulation (CCLR)
• Director of Licensing Standards of Practice (DLSP; Active Play & Safe Play Space)

At the time of inspection, evidence for this facility inspection report (FIR) was based upon:
• FHA's observations
• FHA's review of the CCF's records
• information provided to FHA by the employees

FHA reviewed these 10 areas today:
• licensing • hygiene & communicable disease control
• physical facility • medication
• staffing • nutrition & food services
• policies & procedures • program
• care & supervision • records & reporting

As part of this inspection, FHA completed & provided a risk assessment tool, which includes:
• any noncompliance identified • the CCF's compliance & operational history since being licensed on 31/Aug/2017

Contraventions
Previous Inspection - Not Applicable
Current Inspection - Items reviewed comply with the Act, regulations & standards of practice except for those noted on supplementary pages.

Observed Violations
LICENSING: 10050 - CCLR s.11(1) - A licensee must display in a prominent place in the community care facility both the licence, including any terms or conditions of the licence, and the name of the manager.
Observation: The manager's name wasn't displayed prominently.
Corrective Action(s): Please prominently display the manager's name.
Date to be Corrected: 03/Apr/2018

LICENSING: 10070 - CCLR s.11(4) - A licensee must display in a prominent place in the community care facility the certificate, or a copy of the certificate, of any educator or assistant employed to work in the community care facility.
Observation: 2 employees (1 employee in the GCC (30 mos - SA) & 1 employee in the GCC (< 36 mos)) didn't have their ECE certificates posted prominently.
Corrective Action(s): Please prominently display all employees' ECE or ECEA certificates.
Date to be Corrected: 03/Apr/2018

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: Employee files are kept @ the head office; therefore, FHA wasn't able to review them.
Corrective Action(s): Please keep a copy of employees' CRCs @ the CCF.
Date to be Corrected: 03/Apr/2018

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: Employee files are kept @ the head office; therefore, FHA wasn't able to review them.
Corrective Action(s): Please keep a copy of employees' 3 character references @ the CCF.
Date to be Corrected: 03/Apr/2018

STAFFING: 12060 - CCLR s.19(1)(c) - 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: (c) a record of the person's work history.
Observation: Employee files are kept @ the head office; therefore, FHA wasn't able to review them.
Corrective Action(s): Please keep a copy of employees' work history record @ the CCF.
Date to be Corrected: 03/Apr/2018

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: Employee files are kept @ the head office; therefore, FHA wasn't able to review them.
Corrective Action(s): Several employees' ECE certificates were posted prominently, but not for 2 employees who were onsite today (please see the above violation 10070 - CCLR s.11(4)).
Date to be Corrected: 03/Apr/2018

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: Employee files are kept @ the head office; therefore, FHA wasn't able to review them.
Corrective Action(s): Please keep a copy of employees' immunization status record @ the CCF.
Date to be Corrected: 03/Apr/2018

STAFFING: 12140 - CCLR s.19(4)(a) - A licensee must not employ a person in a community care facility as (a) an educator or an assistant unless the person holds a certificate issued under Division 2 [Employee Qualifications], which must be verified by the licensee using a system established and maintained by the director of the early childhood educator registry,
Observation: Employee files are kept @ the head office; therefore, FHA wasn't able to review them.
Corrective Action(s): Please keep a copy of ECE/ECEA certificate validation @ the CCF.
Date to be Corrected: 03/Apr/2018

STAFFING: 12190 - CCLR s.22(2)(b) - A licensee must ensure that each employee (b) practices implementing the fire drill system at least once each month.
Observation: FHA spoke w/ an employee who stated fire drills haven't been consistently conducted & documented since the CCF relocated to this location.
Corrective Action(s): Please ensure that fire drills are conducted monthly.
Date to be Corrected: 29/Mar/2018

POLICIES AND PROCEDURES: 13050 - CCLR s.56(1)(c) - A licensee must keep current records of each of the following: (c) a record respecting compliance with section 22 (2) (b) and (c) [emergency training and equipment].
Observation: FHA spoke w/ an employee who stated fire drills haven't been consistently conducted & documented since the CCF relocated to this location.
Corrective Action(s): Please ensure that monthly fire drills & annual emergency drills are documented upon completion.
Date to be Corrected: 29/Mar/2018

CARE AND/OR SUPERVISION: 14030 - CCLR s.34(2)(b) - Without limiting subsection (1), a licensee must ensure that (b) the ratio of employees to children attending a community care facility is no less than that permitted in Schedule E.
Observation: a) Infant/Toddler Ratio - Staff to Child Ratio is 1:4 (IT/ECE/ASST).

In the GCC (< 36 mos), there were 6 children w/ an ITE & a responsible adult who stated that she's working towards obtaining her ECEA.
Corrective Action(s): Please ensure that the minimum employee to child ratio is always maintained:
1 - 4 children: 1 ITE
5 - 8 children: 1 ITE & 1 ECE
9 - 12 children: 1 ITE, 1 ECE, & 1 ECEA
Date to be Corrected: 10/Apr/2018

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: FHA reviewed 10 children's files & found that 1 lacked his enrolment date.
Corrective Action(s): Please ensure that all information required under s.57(2) is obtained by children's 1st day of care.
Date to be Corrected: 03/Apr/2018

RECORDS AND REPORTING: 19320 - CCLR s.59(a) - In respect of a record referred to in this Division, a licensee must (a) keep in a single place at the community care facility the records referred to in sections 56 to 58.
Observation: Employee files are kept @ the head office; therefore, FHA wasn't able to review them (other than some employees' ECE certificates that are posted prominently).
Corrective Action(s): Please keep a copy of employees' files onsite.

FHA printed "CCFL Staff Qualifications/Documentation - Child Care," should the licensee choose to use it, in place of keeping employees' files onsite.
Date to be Corrected: 03/Apr/2018


Comments

FHA:
• reviewed this FIR w/ an employee prior to signing & printing • thanks the employees for their time & assistance today

Please visit http://www.fraserhealth.ca/childcare/ for:
• links to the CCALA, CCFL,& DLSP
• the temporary placement/retention application form • the exemption application form
• additional resources

Action Required by Licensee/ManagerAction Required by Licensing Staff
Take corrective action to bring facility into compliance, Provide a written response to LicensingFollow-up Inspection Required
Due Date
Apr 03, 2018
Approximate Follow Up Date
03 Apr, 2018

Click here for FAQ About Inspections.
Click here for a description of each "Category" of violation displayed.