300610663-1-22-2024-06-CC-AFCN-CZR24W-20240122160436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300610663
Report Date: 01/22/2024
Date Signed: 01/22/2024 04:04:44 PM

Document Has Been Signed on 01/22/2024 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ALDERSGATE UNTIED METHODIST CHURCH DAY CARE CENTER		FACILITY NUMBER:	300610663
ADMINISTRATOR:	CAZARES, CHEYENNE		FACILITY TYPE:	850
ADDRESS:	1201 IRVINE BLVD.		TELEPHONE:	(714) 544-5510
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	65	CENSUS: 42	DATE:	01/22/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Director Cheyenne Cazares		TIME COMPLETED:	02:00 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	On 01/22/2024 at 11:45am, Licensing Program Analysts (LPAs), Anna Chan and Karen Navar conducted an onsite inspection for the purpose of an unannounced 3-year Inspection. LPAs met with Director Cheyenne Cazares and toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 9 preschool staff and 42 preschool children, Children are doing indoor activities when LPAs arrived. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7a.m.- 6p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Facility provides AM/PM snack. Lunch is brought from home. Food prep areas were clean and sanitary. Food is properly stored. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by Arrowhead Spring water, and sports bottle with the child’s name on it. The children's bathrooms are clean and sanitary. Children nap on cots, and bedding is stored individually and is taken home weekly for washing. The facility has conducted an emergency drill within the past six months on September 9, 2023. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirements. The California Child Passenger Safety Law was posted by the entrance of the facility. Page 1 of 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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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Document Has Been Signed on 01/22/2024 04:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNTIED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 300610663
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Lead test was done March 2, 2023 and high lead exceedance found in water tested.
	POC Due Date: 02/22/2024
	Plan of Correction
1 2 3 4	Director stated they will schedule re-testing for replaced faucets and will email LPA of re-testing documentation.

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. There is a high exceedance of Lead in the Preschool Yellow rm 15.0ppb, Yellow rm drinking fountain 7.3ppb, Green rm facuet 10.0ppb, Green rm drinking fountain 7.0ppb. Director stated the faucets were replaced but no re-test was done after.
	POC Due Date: 02/22/2024
	Plan of Correction
1 2 3 4	Director stated they will schedule re-testing of faucets that failed Lead Sampling and will email LPA of re-testing documentation. Arrowhead Spring water is used for drinking.

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: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNTIED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 300610663
	VISIT DATE: 01/22/2024

NARRATIVE

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The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material is wood chips and turf grass around the climbing equipment such as slide and appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by Arrowhead spring water and sports bottles with the child’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Staff files were reviewed for staff present during the facility inspection on this date, 6 staff files were reviewed. Health screening and immunizations as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 states, (a) (1) 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 influenza vaccination between August 1 and December 1 of each year. Proof of immunization against pertussis, measles for staff were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 06/2025.

Director Cheyenne Cazares was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

6 Children's records were reviewed, and there was a separate, complete and current record for each child. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out in Brightwheel app was reviewed for compliance. The person who signs the child in and out has their own login ID

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNTIED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 300610663
	VISIT DATE: 01/22/2024

NARRATIVE

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CCC COMPLETED TESTING AND HAS HIGH LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

The facility has done Lead Test on March 2, 2023 with high level of lead.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

In the areas that were evaluated, Two Type B deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. HSC 1597.16(a)(1) Lead Testing and 101700(b) Written Directives for Lead Testing. Please see LIC 809D for deficiencies.

Exit interview conducted and report was reviewed with Director Cheyenne Cazares. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights and deficiencies were discussed. The facility representative was provided with a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

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