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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
CGEE-C3JQ86

FACILITY NAME
Neighborhood Montessori Learning
SERVICE TYPES
302 Group Child Care (30 months to school age)
FACILITY LICENSE #
MLAO-B82R8V
FACILITY ADDRESS
121 E Columbia St
FACILITY PHONE
(604) 524-5555
CITY
New Westminster
POSTAL CODE
V3L 3V7
MANAGER
Jane Sapaen Agustin

INSPECTION DATE
May 27, 2021
ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
1.5
ARRIVAL
03:00 PM
DEPARTURE
04:00 PM
ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# OBSERVED IN CARE
2

Introduction

All care categories were inspected during an unscheduled routine inspection to assess compliance w/:
• the Community Care & Assisted Living Act (CCALA)
• the Child Care Licensing Regulation (CCLR)
• relevant Director of Licensing Standards of Practices (DLSP)

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.
Corrective Action(s): The manager's name must be displayed conspicuously.
Date to be Corrected: 03/June/2021

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: An employee's CRC is addressed to VCH.
Corrective Action(s): All employees' CRCs must be addressed to the licensee (corporation) in order for it to be valid. W/o it, this employee can't work alone w/ children or assist w/ toileting.
Date to be Corrected: 03/Jun/2021

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: An employee's references were missing.
Corrective Action(s): All requirements of CCLR s. 19 must be obtained by employees' 1st day of employment.
Date to be Corrected: 03/Jun/2021

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: An employee's work history was missing.
Corrective Action(s): All requirements of CCLR s. 19 must be obtained by employees' 1st day of employment.
Date to be Corrected: 03/Jun/2021

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: 2 employees' immunization statuses were missing.
Corrective Action(s): All requirements of CCLR s. 19 must be obtained by employees' 1st day of employment.
Date to be Corrected: 03/Jun/2021

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: An employee's ECE certificate hasn't been verified.
Corrective Action(s): All employees' ECE or ECEA certificates must be verified upon hire & each renewal via:
- online (https://earlychildhoodeducator.gov.bc.ca/Public/CertAndRenewal/Certificate_Validation.aspx)
- phone (1.888.338.6622)
Date to be Corrected: 03/Jun/2021

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: The licensee stated that the last fire drill was practiced in Feb/2021.
Corrective Action(s): The fire drill must be practiced monthly.
Date to be Corrected: 31/May/2021

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: The licensee stated that both the emerengy drill & fire drill were practiced in Feb/2021; however, there was no documented evidence of either (or any prior fire drill practices).
Corrective Action(s): Monthly fire drills & annual emergency drills must be documented upon completion.
Date to be Corrected: 31/May/2021


Comments

Summary of FIR #CGEE-C3JQ86 (27/May/2021)

8 violations were observed today, in which corrective actions includes:
• posting the manager's name conspicuously
• implementing the fire drill system monthly
• maintaining a record that the emergency plan was implemented
• obtaining employee documentation

Licensees & employees play a key role in protecting children from, & minimizing the impact of infection & illness. FHA discussed hand washing, cleaning, & physical distancing as per the BC Centre for Disease Control & the BC Ministry of Health's "COVID-19 Public Health Guidance for Child Care Settings" (http://www.bccdc.ca/Health-Info-Site/Documents/COVID_public_guidance/Guidance_Child_Care.pdf).

The inspection was reviewed w/ the manager; however, this report & the Facility Risk Assessment Tool were written @ the Burnaby Health Protection office & emailed to the manager on 31/May/2021.

Please visit https://www.fraserhealth.ca/childcare for additional resources & links to the provincial legislation.

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
Jun 03, 2021

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