300605324-7-24-2019-06-CC-SHAS-BEDQ2R-20190724114735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300605324
Report Date: 07/24/2019
Date Signed: 07/24/2019 11:47:47 AM

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:	CHILDS-PACE		FACILITY NUMBER:	300605324
ADMINISTRATOR:	LEVERE, JOHN		FACILITY TYPE:	840
ADDRESS:	1860 ANAHEIM AVE		TELEPHONE:	(714) 557-7777
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	35	CENSUS: 12	DATE:	07/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rusbelina Gonzalez		TIME COMPLETED:	12:15 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 met with teacher Rusbelina Gonzalez and the purpose of the Annual/Random was relayed to the teacher. 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 is located inside of the local Costa Mesa Community Center and room 4 is the only room that is authorized for care. The site includes a pool that is not adjacent to the center but is on the property. Children do not have access to the pool and the pool is fenced and the gate is locked. This is a Title 5 Program that provides care to children before school from 6:30 AM to 8:15 AM. A school bus transports the children from the center and to and from school and then back to the center each day. After school care is from 2:30 PM to 6:00 PM except for Wednesday's when care is provided from 1:15 PM to 6:00 PM. During summer months the center runs a full day program 6:30am to 6pm. The center is open Monday to Friday. Census was taken and LPA observed 12 school aged children with 2 staff. The facility was toured inside and outside. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Food is prepared on site when children attend full days during non-school days and summer session. Breakfast, lunch and snacks are provided by the center. The menu is posted at least 1 week in advance. Food prep areas appear clean and sanitary. Food is properly stored and the kitchen appears free from hazards. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The center has a restroom that is shared with the community center accessible only by a code. Children are walked to and from the restroom with staff supervision. The children's bathrooms appear clean and sanitary. Children do not nap at the center. The facility has conducted an emergency drill within the past six months. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher in addition to a fire alarm system with strobe lights and an alarm that sounds in the event of a fire. 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: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

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: CHILDS-PACE	FACILITY NUMBER: 300605324
	VISIT DATE: 07/24/2019

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The grassy field where the children play is completely fenced. There is no play equipment outside however the center has a cart with outdoor equipment and toys that are brought outside each day. Sign in/out log was reviewed for signatures and time in and out. At least one staff member present possesses current CPR/First Aid certifications, which expires 03/21. A sample of staff files were reviewed for health screening and immunization's. S1 had no health screening present in the file for review.

Documents/Information to be updated and returned to the Licensing Office within 10 days from 7/24/19:
- Personnel Report (LIC 500)
-Designation of Administrative Responsibility (LIC 308)

This facility provides Incidental Medical Services – IMS. Teacher reported that no children enrolled require IMS services. 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

In the areas that were evaluated, the following deficiency was observed of the California Code of Regulations, 101216.1(g)(2) Title 22, Division 12 at the time of the visit and was cited on the 809-D.

Teacher was advised on how to receive notifications for quarterly updates and was provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee was informed of where to access regulations and forms from CCLD website at: www.ccld.ca.gov Licensee was provided with information on how to access the E-Learning Modules available at https://ccld.childcarevideos.org Exit interview was conducted. Report read out loud, reviewed and discussed. Notice of Site Visit was posted. The representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. 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.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

LIC809 (FAS) - (06/04)

Page: 2 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: CHILDS-PACE	FACILITY NUMBER: 300605324
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2019 Section Cited CCR 101216(g)(2)	1 2 3 4 5 6 7	101216(g)(2) Personnel Requirements. All personnel including the licensee shall have a health-screening report, including specified information, signed by the person who performed it.This requirement was not met as evidenced by Staff#2 not having a health screening on file for review.	1 2 3 4 5 6 7	Teacher agrees to have director submit a copy of completed staf#2 health screening by due date.
	8 9 10 11 12 13 14	This posses a potential health risk to 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: 07/24/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019

LIC809 (FAS) - (06/04)

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