304270591-1-22-2024-06-CC-AFCN-CZR26G-20240122160707

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270591
Report Date: 01/22/2024
Date Signed: 01/22/2024 04:07:17 PM

Document Has Been Signed on 01/22/2024 04:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTER		FACILITY NUMBER:	304270591
ADMINISTRATOR:	CAZARES, CHEYENNE		FACILITY TYPE:	840
ADDRESS:	1201 IRVINE BLVD.		TELEPHONE:	(714) 544-5510
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	65	CENSUS: 4	DATE:	01/22/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Director Cheyenne Cazares		TIME COMPLETED:	04:30 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	On 01/22/24, Licensing Program Analysts (LPAs), Anna Chan and Karen Navar conducted an unannounced onsite inspection for the purpose of a required 3-year visitt. LPAs met with Director Cheyenne Cazares. LPA and Director toured the facility inside and outside and the floor and yard plan were verified. There were 4 school-age children and 1 staff present at around 2:10pm. Children just came from school when LPA arrived. Children usually arrives around 2pm and next batch arrives around 2:40-3:00pm It was determined the facility is not operating within its licensed capacity and within compliance of staffing ratios. 1 staff present is not a qualified teacher. Facility hours are 7:00a.m.- 6:00p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. PM snacks is provided by the facility. Food is prepared on site. Food prep areas were clean and sanitary. Food is properly stored. Menus were posted near the entrance of the facility where it could be seen by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by Arrowhead Spring water and children have their own sports bottles properly labeled with their names, the children's bathrooms are clean and sanitary. The facility has conducted an emergency drill within the past six months on September 19, 2023. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility. Page 1 of 3

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 304270591
	VISIT DATE: 01/22/2024

NARRATIVE

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2 Staff files were reviewed for staff present during the facility inspection on this date. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 (a)(1) a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. Proof of immunization against pertussis, measles for the facility were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 06/2025

Children's records were reviewed, and there was a separate, complete, and current record for each child. In the areas reviewed, 4 children’s files were found to be in full compliance. Sign in/out was reviewed for compliance.
The facility transports children from Elementary schools like Redhill, Arroyo, Tustin Memorial, Tustin Ranch, Guin Foss and Benson.

CCC COMPLETED TESTING AND HAS HIGH LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

The facility has done Lead Test on March 2, 2023 with high lead exceedance.

Currently, there are no medications in the facility. This facility provides Incidental Medical Services (IMS) LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 304270591
	VISIT DATE: 01/22/2024

NARRATIVE

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The outdoor activity space was inspected for compliance. The preschool playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material in the school-age playground is turf grass around the climbing structure such as slide and other climbing equipment which appears to be enough to absorb falls. There is also a one ring basketball court in the paved area of the playground. Drinking water in the outdoor activity space is provided by Arrowhead Spring water and refillable sports bottles with the child’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility, and none was observed during today’s visit.

Transfer Request (LIC9182). The Site Supervisor was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Site Supervisor may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

In the areas that were evaluated, Three Type B deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. HSC 1597.16(a)(1) Lead Testing and 101700(b) Written Directives for Lead Testing and 101216.2(e) Teacher Aide Qualification and Duties. Please see LIC 809D for deficiencies.

An Inspection and exit interview was completed with Director, Cheyenne Cazares. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

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. Failure to post will result in Civil Penalties of $100.00.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 01/22/2024 04:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 304270591
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Lead test was done March 2,2023 and high lead exceedance found in water tested.
	POC Due Date: 02/22/2024
	Plan of Correction
1 2 3 4	Director stated they will schedule re-testing for replaced faucets and will email LPA of re-testing documentation.

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. There is a high exceedance of Lead in the Preschool Rm 1 sink faucet 9.4ppb, Education BLdg drinking fountain 15.0 ppb. Director stated the faucets were replaced but no re-test was done after.
	POC Due Date: 02/22/2024
	Plan of Correction
1 2 3 4	Director stated they will schedule re-testing of faucets that failed Lead Sampling and will email LPA of re-testing documentation. Arrowhead Spring water is used for drinking.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 01/22/2024 04:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ALDERSGATE UNITED METHODIST CHURCH DAY CARE CENTER	FACILITY NUMBER: 304270591
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216.2(e)

Teacher Aide Qualifications and Duties

(e) An aide shall work only under the direct supervision of a teacher. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above 1 Teacher's Aide was left alone with 4 school-age children which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/02/2024
	Plan of Correction
1 2 3 4	The director said she will submit to the licensing office the plan they will implement that will ensure an aide works under the direct supervision of a teacher in accordance to regulation 101216.2(e) by due date 2/2/24. Asst Director replaced the aide within 5 minutes of the LPA observation.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024

LIC809 (FAS) - (06/04)

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