300600710-4-25-2019-06-CC-SHAS-BBKR7D-20190425124610

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600710
Report Date: 04/25/2019
Date Signed: 04/25/2019 12:46:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	NEWPORT CENTER UNITED METHODIST CHURCH PRESCHOOL		FACILITY NUMBER:	300600710
ADMINISTRATOR:	BROWER, DONNA		FACILITY TYPE:	850
ADDRESS:	1601 MARGUERITE		TELEPHONE:	(949) 644-0740
CITY:	CORONA DEL MAR	STATE: CA	ZIP CODE:	92625
CAPACITY:	114	CENSUS: 21	DATE:	04/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Donna Brower		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensed Program Analyst (LPA) Hawkins arrived to the facility for the purpose of conducting an Annual inspection. LPA met with Jennifer Hett, Teacher and toured the facility inside and outside. Census was taken in individual classrooms. The overall census observed was 12 preschool staff and 21 preschool children. Additional classrooms were not in session due to parent/teacher conferences. During the inspection, Donna Brower, Director arrived to the center. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are no bodies of water and no weapons on site. The facility was clean, safe and in good repair at the time of the visit. The restrooms, equipment and furniture were in good repair and free of sharp edges. Disinfectant, cleaning solutions, chemicals and/or poisons were locked or made inaccessible to the children. Menus were posted. The large play yard was free of any injurious toys or hazards. LPA observed a water table and garden fountain filled with water in the large play yard area, but no children were present. The center does not provide lunch or snacks. However, parents provide snacks based on a rotating schedule. There is drinking water accessible to the children both inside the classroom and drinking faucets outside. Children's records were reviewed, and there was a separate, complete medical assessment and emergency information record for each child. Children have been signed in and out with legal signatures. Staff flies were reviewed, and educational background, 1st Aid/CPR cards, health screenings, and immunization's were present. There were 10 staff records that were missing required immunizations (S1, S2, S3, S5, S6, S7, S8, S10, S11, S12) See confidential names list LIC 811 dated 4/25/19. Continued on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NEWPORT CENTER UNITED METHODIST CHURCH PRESCHOOL	FACILITY NUMBER: 300600710
	VISIT DATE: 04/25/2019

NARRATIVE

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An exit interview was completed. The report was read out loud, reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 day will result in a Civil Penalty of $100.00

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NEWPORT CENTER UNITED METHODIST CHURCH PRESCHOOL	FACILITY NUMBER: 300600710
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/16/2019 Section Cited HSC 1596.7995	1 2 3 4 5 6 7	Employees or volunteers at day care center; immunization requirements; records; exemptions: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an	1 2 3 4 5 6 7	Director will have Staff#1,2,3,5,6,7,8,10,11,12 complete the immunization's and a picture of the immunization's' will be sent to the licensing office by the due date of 5/16/19.
	8 9 10 11 12 13 14	influenza vaccination between August 1 and December 1 of each year. This requirement was not met as evidenced by Staff #1,2,3,5,6,7,8,10,11,12 did not have verification of Measles and/or Pertussis immunization's records on file. This poses a potential health and safety risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NEWPORT CENTER UNITED METHODIST CHURCH PRESCHOOL	FACILITY NUMBER: 300600710
	VISIT DATE: 04/25/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Currently, this facility does not provide any IMS services to the children in care. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on LPAs observations the following violation was observed and is being cited in accordance with California Health & Safety Code 1596.7995 is being cited on the attached LIC 809D.

LPA also discussed with the site director regarding the following
1) Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182) including a copy of a state issued identification card. 2) California Child Care Disaster Planhas been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness.
3) E-Learning Modules available at https://ccld.childcarevideos.org
4) Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm)
5) Director was provided Department website at www.ccld.ca.gov for obtaining the quarterly updates and to sign up to childcareadvocatesprogram@dss.ca.gov to receive quarterly updates via email.
6) Chapter Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf.

Continued on page 3

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019

LIC809 (FAS) - (06/04)

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