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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
JMIA-AG7UB7

FACILITY NAME
Morgan Creek Montessori Ltd
SERVICE TYPES
303 Preschool (30 months to school age)
FACILITY LICENSE #
BHAN-7GEV3X
FACILITY ADDRESS
#144 - 3388 Rosemary Heights Cres
FACILITY PHONE
(604) 535-3596
CITY
Surrey
POSTAL CODE
V3S 0K7
MANAGER
Carrie Schepens

INSPECTION DATE
November 30, 2016
ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
2.5
ARRIVAL
01:15 PM
DEPARTURE
03:45 PM
ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# CHILDREN ENROLLED
28

Introduction

An unscheduled routine inspection was conducted to assess compliance with the Community Care and Assisted Living Act (CCALA) and 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 the inspection.

The following areas were reviewed:
· Licensing
· Physical Facility
· Staffing
· Policies and Procedures
· Care and Supervision
· Hygiene and Communicable Disease Control
· Medication
· Nutrition and Food Services
· Program
· 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 operation.

Visit the CCFL website at www.fraserhealth.ca/childcare for:
· Additional resources, and
· Links to the Legislation (CCALA and CCLR)

Useful websites to consider:
· Criminal Record Checks: www.pssg.gov.bc.ca/criminal-record-review
· ECE Registry: www.mcf.gov.bc.ca/childcare/ece

Contraventions
Previous Inspection - Contraventions observed on FIR #SCHE-A4SQHP 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
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: Licensing observed that there was one staff who's ECE Licence to Practice was not displayed in a prominent place.
Corrective Action(s): Please ensure all staff have their licence posted.
Date to be Corrected: December 1, 2016

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: During today's inspection Licensing was unable to review last school years documentation regarding practicing fire drills and emergency evacuation drills. Three fire drills have been practiced this school year, One in October and two in November to make up for the busy month of September, Licensing explained that although time is limited with gradual entry, new children and getting used to the program, it is important that for the first month of operation, at least all staff practice the drill.
As for the annual emergency evacuation drill, both staff had yet to implement a full drill, during a phone call, the manager stated that the last full drill was October 2015 (as she had the papers at home). Licensing reminded the manager that as per Section 60 of the CCLR that all records must be kept for at least one year.
Corrective Action(s): Please ensure at least once a year full emergency evacuation to the designated secondary location (Licensee indicated that she is working on a new location with shelter from the elements) is practiced (by all staff) and recorded.
Date to be Corrected: December 9, 2016


Comments

During today’s inspection one ECE, one ECEA were on site with 8 children. Two parents were also on site a different times observing the program. Licensing spoke with the Manager via telephone.
Licensing observed staff to be attentive to the needs of children, getting down to their level and speaking to them with respectful language and tone. Staffed help children choose activities and helped with problem solving by asking open ended questions or offering suggestions.

The following was observed and/or discussed at time of this inspection with the Manager and/or staff:
· Updated Child Care Licensing Regulations and Director of Licensing Standards of Practice – Active Play were discussed including;
- Removing the requirement for pre-employment doctor’s letter
- Licensee’s responsibility to validate and keep a record for all employees including substitutes, (both current and new hires) who hold a valid ECE Certification (ECE, ECE Assistant, I/T ECE & SN ECE).
- New Policies to be created (Active Play and screen Use Policies)-information has been emailed
- During the phone call with the manager, licensing discussed that an updated Playspace away plan would need to be submitted to Licensing including all of the considerations in the Bulletin Play space Away.
- Licensing notes that all CRC's are current, however one CRC is addressed to another agency and is not site specific. Licensing explained the option of "sharing CRC's" so that all staff have a CRC that is addressed to the Licensee- info on CRC website.


The following resources were provided today:
· Live 5210 Resources

Recommendations provided today include:
- Staff were able to point out different areas within the facility that had items to be used in the event of an emergency, such as food stored on a shelf, a 10 gallon water jug under the snack table and a box on top of a shelf with had a first aid kit, flashlights and radio. Licensing explained that in the event of an actual emergency that trying to collect all of the items and transport them may be challenging as they are trying to get all of the children evacuated safely. Licensing strongly recommends an ongoing assessment of the emergency supplies to ensure quality and quantity. Licensing also suggested keeping all items together in an easy to transport container such as a wheeled suitcase.


Please provide a written response by December 12, 2016 addressing the above cited contraventions as well a a written playspace away plan.

This inspection was reviewed with the Lead Teacher prior to signing.
Thank you for your time and cooperation. Please contact me if you have any questions or concerns; a business card has been provided.

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
Dec 12, 2016

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