304270320-3-9-2020-06-CC-SHAS-BMJPXX-20200309114304

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270320
Report Date: 03/09/2020
Date Signed: 03/09/2020 11:43:18 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:	THORMAN SCHOOL AGE CDC		FACILITY NUMBER:	304270320
ADMINISTRATOR:	BALMACEDA, NURY		FACILITY TYPE:	840
ADDRESS:	1402 SYCAMORE AVENUE		TELEPHONE:	(714) 258-8524
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	70	CENSUS: 0	DATE:	03/09/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nury Balmaceda		TIME COMPLETED:	11:55 AM

NARRATIVE

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Licensing Program Analyst (LPA) Hawkins conducted a Case Management visit at this child care center for the purpose of an increase in capacity. LPA met with Nury Balmaceda and toured center. The facility currently uses rooms portable 2 and 3. The facility is requesting to add room portable #1 to be used to increase the capacity. The facility provides care and supervision for children 4.9 years of age, and enrolled in kindergarten and above to 12 years of age, Monday through Friday, 7:00 AM to 6:00 PM. Office area is located in the corner of portable #2 and will serve as the isolation area for ill children temporarily until parents arrive. The staff bathroom will be used as the isolation bathroom and is conveniently located to the isolation area. Medication will be stored in a locked box in the file cabinet. First Aid kit is complete and located in each room. Sign in / Sign out record was reviewed and meets regulation requirements. Food preparation area is equipped with microwave oven, refrigerator/freezer. Center policy is that lunches and AM/PM snacks are provided by the center. Evaluator reviewed Title 22 Sections 101227 and 101327 with applicant and that the licensee is ultimately responsible to provide adequate, nourishing food. Classrooms are adequately equipped with age and size appropriate furniture and equipment. Drinking water in the indoor activity space will be supplied by pitcher and cups.

Total indoor activity space: 795.335 sqft. divided by 35 equals = 22 children

Total children toilets and sinks:
toilets 12 X 15 = 180 children
sinks 12 X 15 = 180 children
urinals 5 X 10 = 30 children

continued on page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020

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: THORMAN SCHOOL AGE CDC	FACILITY NUMBER: 304270320
	VISIT DATE: 03/09/2020

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The licensing office received a district certified statement stating that classroom portable #1, #2, and #3 are of sufficient size to accommodate public instruction (for up to 35 children each). Fire clearance from the Orange County Fire Authority was received and supports the requested increase in capacity of 35 school age children. Total capacity of 105 in rooms portable 1, 2, 3.

Per Health and Safety Code 1596.806(1)(A), facility is exempt from Title 22 indoor/outdoor square footage and toilet requirements. The facility is located on school ground campus of Thorman Elementary School and classrooms have been certified for public instruction.

Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment. Shade is provide by mature trees and water pitcher provide drinking water.

This file will be subject to a final in office review prior to increase approval.

Applicant was notified about teacher to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, mandated reporter training, immunization requirements against measles, pertussis, and influenza and fingerprint clearance requirements.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

THE FACILITY REPRESENTATIVE WAS INFORMED THAT THE 'NOTICE OF SITE VISIT' MUST BE POSTED FOR 30 CONSECUTIVE DAYS FOR ANY TYPE A VIOLATION. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR. THIS REPORT IS TO BE ON FILE AND ACCESSIBLE FOR PUBLIC REVIEW AT THE FACILITY FOR AT LEAST THREE YEARS

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020

LIC809 (FAS) - (06/04)

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