304270959-6-28-2019-06-CC-SHAS-BDKU5N-20190628151701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270959
Report Date: 06/28/2019
Date Signed: 06/28/2019 03:17:11 PM

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:	OAK CREEK CDC		FACILITY NUMBER:	304270959
ADMINISTRATOR:	LUZZI, AMY		FACILITY TYPE:	840
ADDRESS:	1 DOVE CREEK		TELEPHONE:	(949) 551-3275
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY:	105	CENSUS: 43	DATE:	06/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Amy Luzzi		TIME COMPLETED:	03:40 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	Licensing Program Analyst (LPA) Hawkins conducted an annual inspection of the facility. LPA met with director Amy Luzzi and census was taken. There were a total of 43 school age children with 6 staff observed. Two additional staff returned from lunch during the inspection. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Analyst contacted Regional Office and confirmed clearances for two staff who were not identified on the roster. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture was inspected to ensure safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. The food preparation area was inspected for cleanliness, free of rodents/vermin, appropriate storage of food, and verification of posted menus. There are no weapons, firearms or bodies of water in the facility. The playground was not inspected due to construction being completed on the elementary school site. Currently the school's grass field and activity equipment is being used during outside play which was inspected for safety, good condition. Facility has a functional carbon monoxide detector. Children's files were reviewed for I.D. and emergency information. Staff files were reviewed for educational requirements. Sign in/out records were reviewed. At least one staff member present possesses current Pediatric CPR/First Aid certifications, which expires 4/26/21. The 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. Continued on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019

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: OAK CREEK CDC	FACILITY NUMBER: 304270959
	VISIT DATE: 06/28/2019

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In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Licensee was advised on how to receive notifications for quarterly updates and was provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee was informed of where to access regulations and forms from CCLD website at: www.ccld.ca.gov.
Documents/Information to be updated and returned to the Licensing Office:
1. Updated LIC 308
2. Updated LIC 500

Exit interview was conducted. Report read out loud, reviewed and discussed. Notice of Site Visit was posted. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019

LIC809 (FAS) - (06/04)

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