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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270808
Report Date: 05/09/2019
Date Signed: 05/09/2019 10:45:32 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:CYPRESS LEARNING TREEFACILITY NUMBER:
304270808
ADMINISTRATOR:ERICKSON, MANDYFACILITY TYPE:
850
ADDRESS:5417 BISHOP STREETTELEPHONE:
(714) 527-2744
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY:84CENSUS: 41DATE:
05/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Amanda Erickson, DirectorTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Yesenia Villa conducted an unannounced annual random inspection on this date. LPA met with Director Amanda (Mandy) Erickson. LPA was guided on a tour of the facility by the director. This is a preschool program with a licensed capacity for 84 children. There were 41 children present with six staff during the tour. The center was observed to be within its licensed capacity. There are six classrooms on site designated for different age groups ages 2-4 and ages 4-5 years old.

LPA toured the areas according and inspected the following: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Linens are taken home each week to be washed. Napping cots were observed in each classroom. Per Director, the isolation area is located in the office.

Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. LPA observed a raised linoleum floor in the children’s restroom for class#3. This causes a potential tripping hazard for the children.

LPA observed smoke and carbon monoxide detectors and they were in operable condition. Availability of indoor drinking water was observed in classrooms; children bring in their own water cups. LPA also reviewed fingerprint clearances, children and staff records. Children's records were reviewed for immunization's and Licensing forms. Sign in and out sheets were reviewed. Staff records were reviewed for Immunization's, TDAP, MMR, Influenza, Mandated Reporter training and CPR.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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 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: CYPRESS LEARNING TREE
FACILITY NUMBER: 304270808
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2019
Section Cited
CCR
101238(a)
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Buildings and Grounds-The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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Director states she will repair the floor and submit pictures to the Department as proof of correction by Proof of Correction date of 05/23/19.
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This requirement was not met as evidence: The bathroom in classroom #3 had raised lenolium that can be a tripping hazard for the children. This poses a potential risk to the safety of the children in care.
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Type B
05/23/2019
Section Cited
HSC
1596.7995(a)(1)
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1596.7995(a)(1) Employees or volunteers at day care center; immunization requirements; records; exemptions .Commencing September 1, 2016, 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.
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Director states she will send proof of MMR to the Department for Staff#6. by proof of correction date.
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Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The requirement is not met as evidence by record review of S #6 did not have proof of MMR. #7 This poses a potential risk to the health of children in care.
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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 HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
Page: 3 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: CYPRESS LEARNING TREE
FACILITY NUMBER: 304270808
VISIT DATE: 05/09/2019
NARRATIVE
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During staff file review it was discovered that staff #6. was missing proof of MMR immunization's.

The outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. LPA advised the Director to ensure a walk thru is complete before the children go out to the play area.Required shade and fencing were inspected.

The kitchen was observed to be clean and orderly with sufficient snack supplies. Outdoor play yard has water via water fountains and the children use their personal water cups. Per Director, lunch is brought from home and two morning and afternoon snacks are provided. Care and supervision was evaluated to determine if the basic needs of children are met. All children are adequately supervised.

First Aid supplies were observed in classrooms cabinets. According to director, medication is only administered to a child when accompanied with a doctor's note and is stored in the kitchen under lock and key. Any child requiring Epi Pen medication for allergies are kept in the child's classroom inaccessible to the children.

Incidental Medical Services (IMS) policy was discussed, Per Director there are children enrolled requiring medication to be administered. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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



The following deficiencies are being cited on the 809D page.

An exit interview was conducted with Director Mandy Erickson. Appeal Rights were provided and explained. A notice of site visit was posted and Director was advised failure to keep for 30 days will result in a $100.00 civil penalty fee.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
LIC809 (FAS) - (06/04)
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