304270776-1-31-2023-06-CC-MMAK-CNM2AY-20230131161420

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270776
Report Date: 01/31/2023
Date Signed: 01/31/2023 04:14:23 PM

Document Has Been Signed on 01/31/2023 04:14 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ANAHEIM ELEMENTARY SCHOOL DISTRICT MADISON		FACILITY NUMBER:	304270776
ADMINISTRATOR:	JELINEK, VIVIANA		FACILITY TYPE:	850
ADDRESS:	1510 SOUTH NUTWOOD STREET		TELEPHONE:	(714) 517-8935
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	72	CENSUS: 0	DATE:	01/31/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Apinder Caur and Lynda Durand		TIME COMPLETED:	01:00 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	Page 1 of 2 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of decreasing capacity from 72 preschool children to 24 preschool children by taking Room # 9 off of the license. LPA met with site supervisor, Apinder Caur. LPA also met with Lynda Durand, School Readiness Coordinator from Office of Early Childhood Education with Anaheim Elementary School District who toured the facility with LPA. Census was taken. Currently the facility is licensed for 72 children in rooms Module 1 and Room # 9. The licensee has requested to provide care and supervision for 24 preschool children in room K1 for ages 2.9 to 5 years old, Monday through Friday, 7:30 a.m. to 4:00 p.m. Today there were no children present. According to staff, there were 15 children in the AM session. Staff were in the transitioning for the PM session. There were 3 staff and one parent volunteer present. . A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. (The staff are employees of Anaheim Elementary School District) The State Preschool is a Title 5 Program that offers two morning and afternoon sessions. Morning hours are from 8:am and afternoon sessions are from 12:00 noon to 3:00 pm. The facility provides morning snack and afternoon lunch to children. Children do not nap in this program. The children are dropped off and are singed in and out at the entrance door. The facility has met all the posting requirements. The indoor activity space measurement for the current requested capacity is as follows: Module 1 : 853 square feet. Total indoor space 853 square feet divided by 35 = 24.37 (24 children) Total outdoor activity space measurement is as follows: Outdoor space in front of the classrooms: 6400 square feet divided 75 sq feet = 85.33 (85 children). Continued on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ANAHEIM ELEMENTARY SCHOOL DISTRICT MADISON	FACILITY NUMBER: 304270776
	VISIT DATE: 01/31/2023

NARRATIVE

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There are two sinks in the classroom.
The preschool is not sharing the playground with any other programs. There are 2 toilets and 2 sinks in this classroom that accommodate the number of children. (24 preschool children).
This program does not need to share the restrooms with any other programs.
The classroom is equipped with carbon monoxide detector.
Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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
Orange county Fire authority has approved the requested capacity of 48 preschool children and is on file.
Based on today’s measurements, the sinks and toilets availability, the request of the facility for decreasing the capacity to 24 children will be final reviewed and discussed with management in the Regional Office. The facility will be notified if any additional information is required.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the applicant on file, Lynda Durand.

The following are needed before an updated license is issued

1- DIrector's packet for Apinder Caur.

2- LIC 215 for the applicant and board resolution letter to authorize her as applicant on file.

3- Association of applicant on file to all the School sites.

4- Sketch of the facility for indoor and outdoor.

5- LIC 309

End of report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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