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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
JMIA-BB6RKR

FACILITY NAME
Mann Park Montessori
SERVICE TYPES
302 Group Child Care (30 months to school age)
FACILITY LICENSE #
LSEO-AE3L2A
FACILITY ADDRESS
14560 North Bluff Rd
FACILITY PHONE
(604) 355-4654
CITY
White Rock
POSTAL CODE
V4B 3C9
MANAGER
Fayzeh Mehrgani

INSPECTION DATE
April 12, 2019
ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
2.15
ARRIVAL
12:05 PM
DEPARTURE
02:20 PM
ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# OBSERVED IN CARE
15

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). All areas of the facility were inspected for compliance.

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: 10060 - CCLR s.11(3) - When advertising or otherwise offering services to the public, a licensee must identify the care program being offered.
Observation: Licensing observed a poster advertising care which included ;
- the term "preschool"
- a name (White Rock Montessori Preschool) for the facility that is not what is currently on the licence.

Staff confirmed the poster for advertising was for this location.
Corrective Action(s): Please ensure that any advertising only includes the care program which is on the licence, in this case the facility is licensed for Group Child Care (30 months to school age)
Date to be Corrected: April 23, 2019

PHYSICAL FACILITY, EQUIPMENT AND FURNISHINGS: 11010 - CCLR s.13(1) - A licensee must ensure that a healthy and safe environment is provided at all times while children are under the supervision of employees.
Observation: Licensing observed the following;
- There was a large/tall shelf inside the facility that is not secured to the wall- there was also large boxes stored on the top (topple hazard)
-As this is a shared space, there are high shelves/piano top which display heavy metal trophies- risk of falling on a child
- Children have access to the community kitchen, there are drawers that are accessible to children which includes many large kitchen knives and large scissors. Note: staff included that children are taught there limits and do not enter the kitchen area.
Corrective Action(s): Please ensure a safe environment while children are in care.
Date to be Corrected: April 15, 2019

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 (CORRECTED DURING INSPECTION): In review of 3 staff files, two of the files were without evidence of the staff's immunization status.
Corrective Action(s): Please ensure staff files are current and complete.
Date to be Corrected: Both staff completed the Child Care Immunization Status Form and put on file.

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: Upon review of the fire drill documentation drill form, licensing notes that a Fire Drill is practiced once a month. There was no written documentation of the emergency plan being implemented annually.
Staff confirmed that they had not yet participated in the annual drill.
Corrective Action(s): Please ensure that all staff participate in an annual Emergency evacuation drill, in which your policy is followed including what you will take and where you will go.
This drill must be documented (Sample Documentation Form Provided)
Date to be Corrected: April 18, 2019

RECORDS AND REPORTING: 19070 - CCLR s.57(2)(a) - A licensee must keep, for each child, a record showing the following information: (a) name, sex, date of birth, medical insurance plan number and immunization status.
Observation: 2/5 children's files that were reviewed (out of the 30 files) were without an MSP #
Corrective Action(s): Although the specific two MSP#'s were added to the children's files during the inspection, Licensing discussed that for future registrants what system will the facility implement to ensure all file requirements are current and complete.
Date to be Corrected: April 23, 2019

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: 5 out of 30 children files were reviewed, the following was noted;
-3/5 files were without Doctor's name and number (action taken to correct this started during the inspection).

Corrective Action(s): Please ensure all children's files are current and complete.
Licensing discussed that if a child doesn't have a family doctor then it would be acceptable to document a name and phone number of a medical clinic the child has attended.
Although immediate steps were taken to address these identified contraventions, Licensing discussed that it was just a random selection of files reviewed and this would be a good opportunity to review all children's records to ensure all files are current and complete. (Child Records Document was provided).
- Intent of "emergency contact" was discussed
Date to be Corrected: April 23, 2019


Comments

Summary of Inspection:

At the inspection dated April 12, 2019 there were 15 children and 2 staff present.
At this inspection the above noted contraventions were identified.
Action required by the licensee includes providing a written response April 23, 2019.
Actions required by Licensing include reviewing the written response and conducting a follow up inspection.

As part of this Routine Inspection a Facility Risk Assessment Tool was completed and a copy was provided.

The following education /recommendations were provided:
· Promoting Active Play in the program
· Active Supervision- practices
· Potential of Lead in Drinking Water
· Reportable Incident Reporting – ensure notification to Licensing within 24 hours, if you cannot reach your LO please contact the Duty Line 604-587-3936

The following resources were provided:

· Fire Drill/Emergency Evacuation Drill Documentation sheet
· Reportable Incident Bulletin
· Safety Alert- Active Supervision
· Staff Immunization Form

Visit the CCFL website at www.fraserhealth.ca/childcare for additional resources, and links to the Legislation (CCALA and CCLR).

Please contact me if you have any questions or concerns; a business card has been provided previously.

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 23, 2019
Approximate Follow Up Date

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