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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614108
Report Date: 11/21/2019
Date Signed: 11/21/2019 09:55:31 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:SANTA ANA USD/MITCHELLFACILITY NUMBER:
300614108
ADMINISTRATOR:VELEZ, VICTORIAFACILITY TYPE:
850
ADDRESS:3001 WEST HARVARDTELEPHONE:
(714) 430-5600
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:17CENSUS: 0DATE:
11/21/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Head Start Coordinator Charlotte ErvinTIME COMPLETED:
10:00 AM
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An Informal Meeting was conducted on this day in the Orange Regional Office. Present during the meeting were Licensing Program Manager (LPM) Patricia Magana, Licensing Program Analyst (LPA) Leonor Barajas, and Santa Ana Unified School District/Mitchell: Head Start Coordinator Charlotte Ervin.

The purpose of this informal meeting is to discuss the Child Care Facility most recent inspections and the history of the facility.

Operation of a Child Care Center - (Type A)

* 101229(a)(1)- (11/08/2016)-Responsibility for Providing Care and Supervision: According to the self reported incident, A three-year-old child left the classroom at dismissal time and walked to the front office of the school by himself. The staff did not notice the child had left the classroom until the front desk office staff notified the staff that the child was in the office. It was estimated that the child was left unattended between five to eight minutes.

**During today’s meeting it was discussed with Head Start Coordinator: Charlotte Ervin, who stated according to report a child walked to the office alone.

Head Start Coordinator stated facilities are in compliance due to head count and roll call at multiple times of the day to keep accountability of children. Also during daily return staff are doing a head count and documenting, inside or outside, walking out of classroom, all teachers are calling out children names.

Head Starts Coordinator states she monitors sheets and makes sure Staff are doing head count before they go to restroom, meal times, before going outside to play in playground. Staff are making sure records match with front office and in classroom. Coordinator also stated children also now wear red vest outside the classroom, for school and facility to identify head start children. Facility also installed an informal detection alarm on facility doors.


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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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: SANTA ANA USD/MITCHELL
FACILITY NUMBER: 300614108
VISIT DATE: 11/21/2019
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Head Start Coordinator will be providing the department written policies and procedures that have been implemented since incident took place.

The following was also discussed with the Director:

*The Director was advised that it is her responsibility to know & understand Title 22 Regulations.

* The Director’s facility must be in compliance at all times.

The Director was provided the following documents during this meeting:

* The licensee will review the Department's Child Care Video Series at https://ccld.childcarevideos.org/ (Videos included are: Supervising Children in Child Care Center’s )

The Director will check the Department's website www.ccld.ca.gov for any updates on a quarterly basis and will ensure compliance with California Code Title 22 Regulations. The Director was advised that a copy of this report will be forwarded to the Resource and Referral Agency.

*The Director was provided a Lead Pamphlet

* Upon receipt of this report pertaining to a conference conducted by a local Licensing Agency in which issues were discussed, the Director must:

1) Provide a copy of this report to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).

2) Obtain signature and date from the child's parent/guardian on the Acknowledgement of Receipt of Licensing Reports (LIC 9224).

3) Keep a record immediately upon receipt of the completed and signed LIC 9224 acknowledging receipt of this report in the child's file.

Exit interview conducted with Santa Ana Unified School District Head Start Coordinator: Charlotte Ervin.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
LIC809 (FAS) - (06/04)
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