300613937-1-19-2021-06-CC-STOE-BXESYU-20210119131805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300613937
Report Date: 01/19/2021
Date Signed: 01/19/2021 01:18:12 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:	ANAHEIM ELEMENTARY SCHOOL DISTRICT MANN		FACILITY NUMBER:	300613937
ADMINISTRATOR:	JELINEK, VIVIANA		FACILITY TYPE:	850
ADDRESS:	600 WEST LA PALMA		TELEPHONE:	(714) 517-8727
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92805
CAPACITY:	48	CENSUS: 0	DATE:	01/19/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Viviana Jelinek, Director		TIME COMPLETED:	11:29 AM

NARRATIVE

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A case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence. Applicant submitted an application requesting a decrease in capacity. The purpose for today’s inspection was to evaluate the facility for decrease in capacity. Facility is currently licensed for 48 preschool children in rooms #57 and #58 only and is requesting to decrease capacity to 24 children. LPA met with Viviana Jelinek Director and toured the facility. Operating hours are 8:00 am-11:00 am- 12:30 pm -3:30 pm Mon-Fri. Children are participating in virtual learning; therefore, there are no children present today.

A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The main school office has an isolation area for ill children temporarily until parents arrives. The staff bathroom conveniently located near the main entrance of the center will be used as the isolation bathroom. Medication will be stored in each classroom, in a locked cabinet, inaccessible to children in care. First Aid kit is in each classroom, in a combination lock backpack. Sign in / sign out record meets regulation requirements.

The facility has a food is provided by a food program. Facility offer breakfast for the morning session and lunch for the afternoon session.

Classrooms are adequately equipped with age and size appropriate furniture and equipment. Drinking water in the indoor activity space is readily available (drinking fountain).

Inside Activity Space measurements are as follows:
Total indoor activity area:
Room #57: 30.11 x = 28.03= 843 sqft. divided by 35= 24 children
Room #58: 30.11 x = 28.03= 843 sqft. divided by 35= 24 children
Total= 1,686 sqft. divided by 35 = 48 children

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2021

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: ANAHEIM ELEMENTARY SCHOOL DISTRICT MANN	FACILITY NUMBER: 300613937
	VISIT DATE: 01/19/2021

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Total children toilets and sinks:
toilets 5 X 15 = 75 children
sinks 5 X 15= 75 children

Total outdoor space = approximately 15,720 square feet sufficient to accommodate 209 children.

Playground is completely enclosed by 5-foot-high chain link fence. Outdoor activity is supplied with age and size appropriate equipment. An adequate amount of cushioning material (rubber foam) is in place under and around all climbing equipment. Adequate shades on the playground (table area). Two water fountains on the playground provide drinking water.

Based on today's inspection, facility has enough space for the requested decrease capacity of 24 preschoolers (ages 3-5 years old). Operating hours are 8:00 am-11:00 am- 12:30 pm -3:30 pm Mon-Fri.

Facility provides Incidental Medical services.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

Facility meets all licensing requirements and file will be submitted for approval.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director 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.

A license for 24 preschool children will be issued upon approval.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2021

LIC809 (FAS) - (06/04)

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