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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370178
Report Date: 09/06/2019
Date Signed: 09/09/2019 07:56:25 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:COVENANT CHRISTIAN PRESCHOOLFACILITY NUMBER:
304370178
ADMINISTRATOR:REIS, MAUREENFACILITY TYPE:
850
ADDRESS:1855 ORANGE-OLIVE ROADTELEPHONE:
(714) 998-4852
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY:60CENSUS: 22DATE:
09/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tracey Aresenault - Substitute DirectorTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Jungmi Han conducted an unannounced annual/random inspection of the facility on today's date. LPA Han toured the facility with the substitute director, Tracey Arsenault inside and outside. Tracey Arsenault was facility teacher for 10 years and director for 2 years. Tracey was called by school principal for substitute director position since current director left the facility for medical leave reason. Census was taken in individual classrooms. All children were at the gym for play time. The overall census observed was 4 preschool staff and 22 preschool children. A review of staff criminal clearance records 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. Operating hours are 7:00 am- 6:00 pm, Mon-Fri. The facility was toured inside and outside. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

The facility currently has two waivers: share the restroom facilities with the private elementary school children and share the outdoor space with another program. The outdoor space is including gym per LPM Hanson who issued waiver for the facility. The restroom that is inside of gym is only one which it has a waiver to share with other program children. The restroom near by preschool gate and director’s office is only for preschool children use only per LPM Hanson.

The items which could pose a danger to children such as detergents, cleaning compounds, and medications were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Snacks are prepared on site. Children brings own lunch. Food prep areas appear clean and sanitary. Food is properly stored. LPA observed there are 2% milk in refrigerator for children. Substitute director stated it is for preschool children. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary. Children nap on cots and bedding is taken home weekly to be washed by parents.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
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: COVENANT CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304370178
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited

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1596.808 (a)(1) Commencing January 1, 2012, … all of the following requirements for beverages served by the day care provider to children...(1) Whenever milk is served, serve only lowfat (1 percent) milk or nonfat milk to children two years of age or older. This requirement is not met as evidenced by:
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Based on observation and interview with director, LPA observed 2% milk for preschool children. Director stated it is for 3-5 years old children. This poses an immediate Health and Safety risk to the children in care.
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Type B
09/06/2019
Section Cited

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101161(a) Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by:
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Based on waiver record review, the restroom next to the director's office and gate is only for preschool children. Staff#1 and Staff#2 stated it is used with other program, but no co-mingle. This poses an immediate Health and Safety risk to the 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: COVENANT CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304370178
VISIT DATE: 09/06/2019
NARRATIVE
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AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
Always place infants on their backs for sleeping
Use only a tight-fitting sheet on the crib or play yard mattress
Do not hang any items from the crib or above the crib
Keep all items, including blankets, out of the crib or play yard
Pacifiers may be used as long as they do not have items attached to them
Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold
Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

Documents/Information to be updated and returned to the Licensing Office; (DUE DATE: 9/30/3019)
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal Rights and deficiencies were discussed. The director was provided a copy of their appeal rights (LIC 9058 01/16) 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. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
The director 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. The “Notice of Site Visit” must be posted on or adjacent to the door.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: COVENANT CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304370178
VISIT DATE: 09/06/2019
NARRATIVE
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The facility has conducted an emergency drill within the past six months. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. The playground was completely fenced. The playground equipment appeared in safe condition. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls.

Sign in/out procedure was reviewed for compliance. During today's visit staffing ratios were being met. At least one staff member present possesses current CPR/First Aid certifications, which expires 08/2020. Children's and staff files were reviewed for compliance. Children's and staff files were in substantial compliance.

The facility does provide Incident Medical Services.
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

Based on LPAs observations, record reviews, and interviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101161(a)(1) and Health and Safety 1596.808(a)(1). Please refer to attached 809D for documentation of deficiencies.

Proof of immunizations against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792.

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4