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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
SCLY-ARKQUN

FACILITY NAME
Little Leaders Childcare Centre Inc.
SERVICE TYPES
302 Group Child Care (30 months to school age)
FACILITY LICENSE #
TBIU-9HBUT3
FACILITY ADDRESS
#4 - 33575 Mayfair Avenue
FACILITY PHONE
(604) 217-1404
CITY
Abbotsford
POSTAL CODE
V2S1P6
MANAGER
Sukhbinder Gill

INSPECTION DATE
September 25, 2017
ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
2.25
ARRIVAL
11:15 AM
DEPARTURE
01:30 PM
ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# CHILDREN ENROLLED

Introduction

An unscheduled routine 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). Evidence for this report was based on the licensing officer’s observations, review of the facility records, and information provided by the facility staff at the time of inspection.
The following areas were reviewed:
· Licensing · Hygiene and Communicable Disease Control
· Physical Facility · Medication
· Staffing · Nutrition and Food Services
· Policies and Procedures · Program
· Care and Supervision · Records and Reporting

As part of this Routine Inspection a Facility Risk Assessment Tool is completed and a copy is provided. The Risk Assessment includes non-compliance identified during the routine inspection, and a 3 year ‘historical’ review of the facility’s compliance and operation.
Visit the CCFL website at http://www.fraserhealth.ca/health-info/health-topics/child-care/ for:
· Additional resources, and
· Links to the Legislation (CCALA and CCLR)

Contraventions
Previous Inspection - Contraventions observed on FIR #LJON-ADXRR4
JBES-A4VPVG have been corrected except for those noted on supplementary pages.
Current Inspection - Items reviewed comply with the Act, regulations & standards of practice except for those noted on supplementary pages.

Observed Violations
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 5 staff files found that 1 staff's reference letters had not been validated. The manager stated that this is because she use to work with this staff and knows her personally.
Corrective Action(s): Please ensure that reference checks are completed for each staff member.
Date to be Corrected: October 3, 2017

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 5 staff records found that 2 certificates have not been validated.
Corrective Action(s): Please ensure that each staff's certificate is validated.
Date to be Corrected: October 3, 2017

STAFFING: 12200 - CCLR s.22(2)(c) - A licensee must ensure that each employee (c) practices implementing the emergency plan at least once each year.
Observation: Discussion with the manager determined that the emergency drill was not practiced this past year and that she was unsure as to what it was. Licensing discussed with the manager the expectations of the emergency drill and the importance of practicing it at least once each year.
Corrective Action(s): Please ensure that the emergency drill is practiced at least once each year.
Date to be Corrected: October 3, 2017

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: Discussion with the manager determined that fire drills are being practiced each month but not always recorded. Two inspections (July and September) were recorded in the manager's planner but the others were not.
This is a repeat contravention from the past 2 routine inspections (inspection #JBES-A4VPVG and LJON-ADXRR4).
Corrective Action(s): Ensure that fire drills are recorded and that the record is kept.
Date to be Corrected: Sept 26, 2017

RECORDS AND REPORTING: 19100 - CCLR s.57(2)(d) - A licensee must keep, for each child, a record showing the following information: (d) name and telephone number of a parent, medical practitioner and emergency contact.
Observation: Review of children's records found that at least 2 children did not have medical practitioners listed.
Corrective Action(s): Please ensure that each child's records have the name and phone number of a medical practitioner listed.
Date to be Corrected: October 3, 2017

RECORDS AND REPORTING: 19250 - CCLR s.58(2)(a) - The licensee must (a) develop the care plan in consultation with a parent of the child requiring extra support and any person requested by the parent.
Observation: Discussion with the manager determined that there is a child requiring extra support where there is no care plan outlining their diagnosis and the support to be provided to the child. The manager stated that all the staff know how to support the child.
Corrective Action(s): Please ensure that each child who requires additional support has a care plan developed with the support of the parents.
Date to be Corrected: October 3, 2017


Comments

The licensing officer (LO) provided the manager with a copy of temporary placement approvals for 4 children.
An application to amend the license was received on August 14, 2017. The manager/licensee is now ready to move forward with the amendment to expand the daycare into the unit next door. Licensing inspected the space and has requested that the measurement for the facility be provided. Drawings were provided with the overall square footage of the proposed rooms but not the length and the width of the space. The proposed unit has 4 large windows in the front on the unit. The licensee is proposing to put a door between the two units to make them adjoining. The owner is going to forward an email to the LO from the city confirming that the proposed unit would have the same address as the current as it would be accessed from another street.

Action Required by Licensee/ManagerAction Required by Licensing Staff
Take corrective action to bring facility into compliance, Provide a written response to LicensingNo action required
Due Date
Oct 03, 2017

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