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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613937
Report Date: 05/07/2019
Date Signed: 05/07/2019 10:33:19 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:ANAHEIM ELEMENTARY SCHOOL DISTRICT MANNFACILITY NUMBER:
300613937
ADMINISTRATOR:JELINEK, VIVIANAFACILITY TYPE:
850
ADDRESS:600 WEST LA PALMATELEPHONE:
(714) 517-8727
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:48CENSUS: 33DATE:
05/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jacqueline Flores-Child Development SpecialistTIME COMPLETED:
11:00 AM
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An inspection for an Random Annual of the facility was conducted by Licensing Program Analyst (LPA) Andrea Taylor. 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. Operating hours are 8:00 am-11:00 am- 12:30 pm -3:30 pm Mon-Fri. Census was taken. LPA observed 33 preschool children with 4 staff members and 2 parent volunteers. The facility was toured inside and outside.
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 not prepared on site; breakfast and lunch are provided by the school district. Food is properly stored. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary. Children do not nap due to this program is only half day.
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. The playground was completely fenced. The playground equipment appeared in safe condition. Sign in/out procedure was reviewed for compliance. During today's visit staffing ratios were being met. At least one staff member present possesses current CPR/First Aid certifications, which exp. 5/10/20. Proof of immunization's against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. Certificate of completion for Mandated reporter on file for all staff. http://childcare.mandatedreporterca.com. Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2019
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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