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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
LPEN-B64TM6
FACILITY NAME
Club K.I.D.S. Hatzic - Room 130		SERVICE TYPES
305 Group Child Care (School Age)
FACILITY LICENSE #
LPAO-7J6MJL
FACILITY ADDRESS
8465 Draper Rd		FACILITY PHONE
(604) 302-6083
CITY
Mission		POSTAL CODE
V2V 5V6		MANAGER
Samantha Brown
INSPECTION DATE
November 01, 2018		ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
1.5
ARRIVAL
02:00 PM		DEPARTURE
03:30 PM		ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine		# CHILDREN ENROLLED
31
Introduction

An unscheduled routine inspection was conducted to assess compliance with the Community Care & Assisted Living Act (CCALA), the Child Care Licensing Regulation (CCLR) and the relevant Director of Licensing Standards of Practice (DOLSP). 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
· Physical Facility
· Staffing
· Polices & Procedures
· Care & Supervision
· Hygiene and Communicable Disease Control
· Medication
· Nutrition and Food Services
· Program
· Records and Reporting

As part of the 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/childcare for:
· Additional resources and
· Links to the Legislation (CCALA & CCLR)
If you have any questions regarding this report feel free to contact me, a business card was provided
Contraventions
Previous Inspection -
Current Inspection - Items reviewed comply with the Act, regulations & standards of practice except for those noted on supplementary pages.
Observed Violations
LICENSING: 10120 - 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: On Oct. 18, 2018 there were 17 children in care. The facility is licensed for a maximum capacity of 16 children. The Manager stated that on a couple occasions there have been 17 children in care.
Corrective Action(s): Ensure that the maximum capacity of children in care is not exceeded.
Date to be Corrected: 1-Nov-2018

RECORDS AND REPORTING: 19030 - CCLR s.55(2)(a) - A licensee must notify the medical health officer within 24 hours after (a) a child is involved in, or may have been involved in, a reportable incident described in Schedule H while under the care or supervision of the licensee.
Observation: 2 reportable incidents in the last 2 months were not reported to the Licensing Officer. A conversation about schedule H was had.
Corrective Action(s): Ensure that reportable incidents are reported to a Licensing Officer within 24 hours.
Date to be Corrected: 1-Nov-2018

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: 5 children requiring care plans did not have one. A discussion was had with the Manager about CCLR s. 58 and the information that must be recorded in the care plan.
Corrective Action(s): Please create a care plan for children that require extra support or life saving medication.
Date to be Corrected: 5-Nov-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: The policies and procedures were unavailable for review. The Manager stated that each staff person was given a personal copy but was unsure if there was a copy on site. Daily attendance records were available for October but were unavailable for review for the previous months. A conversation with the Manager about the requirement to keep records for children for at least 2 years.
Corrective Action(s): Ensure that records referred to in CCLR s. 56 to 58 are kept in a single place at the community care facility.
Date to be Corrected: 15-Nov-2018
Comments

Licensing was unable to review staff documentation at time of inspection and Licensing will go to the Leisure centre to view staff files at a later date.

Discussed with the manager the following information
· Active supervision and the need to have visual and auditory supervision of the children. The Manager stated that the staff walk the children to the bathrooms and wait for them before returning to the group.
· The necessity of flushing the taps prior to use every morning. This can be done by letting the water run at the tap for 5 minutes.
· The Manager is aware that she must contact a Licensing officer within 24 hours after a reportable incident occurred. This can be done by contacting the Geographical Licensing Officer or the Licensing Officer on duty. A discussion about types of reportable incidents was had. The Licensing Officer showed the manager that the information on reportable incident types is located on the back of the form or in schedule H. An incident report bulletin was provided to the Manager.
This report was reviewed with the Manager and a copy was mailed to the facility with the risk assessment.

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
Nov 09, 2018		Approximate Follow Up Date
15 Nov, 2018
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Click here for a description of each "Category" of violation displayed.