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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605317
Report Date: 10/10/2019
Date Signed: 10/10/2019 03:26:44 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:CITY OF LA HABRA PRESCHOOLFACILITY NUMBER:
300605317
ADMINISTRATOR:PEREZ, JOHANNAFACILITY TYPE:
850
ADDRESS:1440 W WHITTIER BLVDTELEPHONE:
(562) 697-1471
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:39CENSUS: 20DATE:
10/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Johanna Perez, Site SupervisorTIME COMPLETED:
03:45 PM
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An unannounced annual/random inspection was conducted by the Licensing Program Analyst (LPA) Torrence. Upon arrival, LPA met with Amber Navarro, Teacher, who guided analyst on a tour of the Early Childhood Setting indoors. LPA toured the playground. Site Supervisor Johanna Perez arrived around 12:25 p.m. Census was taken. There was a total of 20 napping children with four staff supervising. Operation hours are 6:15 a.m. to 6:00 p.m.; Monday to Friday. This is a title 5 program, state preschool. During this inspection, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratio. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture were inspected to ensure it's in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. This facility provides breakfast, lunch, and PM snacks. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material.

Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (Measles, Pertussis, and Flu vaccines). Staff #4 record is missing proof of Pertussis vaccine. Facility has a current disaster drill log. Facility have a current children's roster available. A carbon monoxide detector and fire alarm were located at this facility. A sample of children's files were reviewed for completeness.



SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CITY OF LA HABRA PRESCHOOL
FACILITY NUMBER: 300605317
VISIT DATE: 10/10/2019
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This facility provides Incidental Medical Services Plan. LPA reviewed storage of medication and equipment/supplies, and administrative records. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov . Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

Staff has completed the Mandated Reporter Training.

During this inspection, there were deficiencies cited per CA Code of Regulations Title 22, Division 12, H&S 1596.7995(a)(1) Immunization and Section 101227 Food Services. The deficiencies were being cited on the attached LIC 809D.

Exit interview was conducted. Report reviewed and discussed. 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.Notice of Site Visit was posted during the visit. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: CITY OF LA HABRA PRESCHOOL
FACILITY NUMBER: 300605317
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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H&S 1596.7995(a)(1) Employees or volunteers at day care center; immunization requirements; records; exemptions..... The requirement is not met as evidence by record review of staff #4. Staff #4 is missing proof of Pertussis vaccine. This poses a potential risk to the health of children in care.
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Type B
10/10/2019
Section Cited

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Food Services. LPA observed expired food in the refrigerate. Food expired dates were a couple of days over due. This poses a potential risk to health of children in care.

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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 LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3