300614039-8-8-2019-06-CC-YVIA-BEUQ54-20190808115119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300614039
Report Date: 07/31/2019
Date Signed: 08/08/2019 11:51:41 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:	ABC DEVELOPMENT PRESCHOOL #3		FACILITY NUMBER:	300614039
ADMINISTRATOR:	CALVILLO, LISA		FACILITY TYPE:	840
ADDRESS:	9972 GRAHAM ST		TELEPHONE:	(714) 821-4222
CITY:	CYPRESS	STATE: CA	ZIP CODE:	90630
CAPACITY:	60	CENSUS: 14	DATE:	07/31/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Janice LeBrun, Owner		TIME COMPLETED:	03:30 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	An unannounced inspection was conducted on this date by Licensing Program Analyst (LPA) Yesenia Villa for the purpose of capacity increase for the school age program at this location. LPA met with Owner, Janice LeBrun and Director Lisa Calvillo. This facility is located on Juliet Morris Elementary School grounds. The current capacity for school age program is 60 children and the licensee is requesting to increase capacity by 36 children bringing the total capacity to 96 children. The classroom the licensee is interested in licensing is classroom #43 located towards the back of the school. There were 14 children present with two staff members during today's inspection. The applicant indicates the hours of operations for the school age program will be from 2:30pm to 5:30pm, Monday through Friday. Per Licensee on days that are minimum days which happen once per month (dates vary) the school age children will use classroom#43 at 1:00pm. For days in which the school is closed, and the day care is open, classroom #43 will be used all day from 6:30 am-6:00pm Monday through Friday. There are currently a total of three classrooms identified as classroom A1, B2 and C3 on the premises. Classrooms #B2 and #C3 will be used for school age children once the enrollment drops during the evening hours in classroom #43. This facility has a separate preschool license issued to the same licensee on the premises. LPA toured the entire facility indoors and outdoors. Fire clearance from the Orange County Fire Authority was received on 07/17/2019 and supports the requested capacity.The following measurements were obtained Indoor: Classroom B2: 818 square feet Classroom C3: 837 square feet Classroom 43: 920 square feet Additional classroom requested Classroom A1:820 square feet NOT used for school age children, Total square feet:3395 counting room A1, Total square feet for room#43 is 920/35 square feet= 26 children.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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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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: ABC DEVELOPMENT PRESCHOOL #3	FACILITY NUMBER: 300614039
	VISIT DATE: 07/31/2019

NARRATIVE

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Toilets and sinks:
Toilets 12 X 15 = 180 children
Sinks 8 X 15 = 120children

This facility shares the playground that is used by the elementary children for outdoor play. However, during the hours of operation, the school age children will not share with the elementary kids as the operating hours will be after school hours. There is adequate shade provided by a roof top over the school lunch benches. The playground equipment is safe, fenced and there is enough cushioned material to absorb a fall provided by wood chips.

Outdoor Yard :10,196 square feet/75=135 Children

The following was observed:
-There is a working smoke detector and fire extinguisher that meet statutory requirements
-Classrooms are adequately equipped with age and size appropriate furniture and equipment
-The staff break area will serve as the isolation area for ill children until parents arrive.
-Water is available by water fountains indoors and by pitchers and cups outdoors.
-Playground is fully enclosed by an appropriate fence.
-Outdoor activity area is supplied with age and size appropriate equipment.
-There is adequate shade provided outdoor by trees and alternate shade.
-A separate staff restroom is available for adults.
-Medication will be stored in the Directors office inaccessible to children.
-First Aid kit is complete.
-Sign in/Sign out procedure was reviewed and meets regulation requirements.

Applicant was notified about emergency/disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, mandated reporter training, staff and other individual immunization/proof of immunity requirements against measles, pertussis and influenza, and fingerprint clearance requirements. Facility was advised a certificate of completion for Mandated Reporter training for staff members shall be kept on file.

Facility was advised on how to receive notifications for quarterly updates and provided contact information on our web site at www.ccld.ca.gov. Page 2 of 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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: ABC DEVELOPMENT PRESCHOOL #3	FACILITY NUMBER: 300614039
	VISIT DATE: 07/31/2019

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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)/ (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

Based on today’s measurement and the sink and toilet availability, the center has enough activity space to support the capacity of 86 children. An updated license will be issued pending a final in office review by a Licensing Program Manager.

Licensee was advised that in order to meet her capacity increase request of 36 children in room #43 the following needs to be submitted to the Department.

According to section 1596.806 Exemption from square footage, toilet, isolation space, outdoor activity space and fencing requirements. (A) Evidence that the building was approved as a classroom by the office of the State Architect. (B) A certification statement signed by the superintendent of the schools, or his or her designee, in the district where the school age child care program is located, that the classroom building is of sufficient size to accommodate public instruction. The school district may make this certification regardless of the ownership of the classroom.

An exit interview was conducted with owner, Janice LeBrun. This report was reviewed and discussed. Licensee was also advised the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed.

The Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

Page 3 of 3 end of report.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

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