304370182-8-29-2019-06-CC-SHAS-BFHPCM-20190829111211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370182
Report Date: 08/29/2019
Date Signed: 08/29/2019 11:12:23 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:	NMUSD COLLEGE PARK PRESCHOOL		FACILITY NUMBER:	304370182
ADMINISTRATOR:	GODDARD, ANGELA		FACILITY TYPE:	850
ADDRESS:	2380 NORTE DAME ROAD		TELEPHONE:	(714) 424-7960
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	24	CENSUS: 0	DATE:	08/29/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Michelle Oneill-Coordinator; Kimberly Nguyen- Teachers Assistant		TIME COMPLETED:	11:25 AM

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	The purpose of this visit was to conduct an annual visit of the facility. Licensing Program Analyst (LPA) Hawkins met with Kimberly Nguyen- Teachers Assistant in room K1 at the time of the visit. LPA toured the facility inside and outside. Upon arrival LPA was informed that school does not start until September 3rd and during today's inspection parent's arrived for a meet and greet. Early childhood coordinator, Michelle Oneill was contacted via phone and explained that staff are still in the process of being hired including new director , and as a result only two staff files were available for review. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. (The staff are employees of Newport Mesa Unified School District). Coordinator arrived to the facility during the inspection with staff files. Staff files were reviewed for mandated reporter training, immunization records, and testing for Tuberculosis. Staff files were found to be complete and in order. Carbon Monoxide, fire extinguisher, and drinking water were inspected. Medication, food storage, and sign in/out, were not inspected. Posting requirements were not reviewed. No children's files were reviewed during todays visit due to no enrollment as of today. LPA was informed by the coordinator that this facility does provide Incidental Medical Services (IMS) to children at this time, however no medication storage was observed. LPA informed the coordinator that there will be a follow up visit to conduct a complete facility inspection and review children's and staff's files after school have started. Facility will provide a new director's packet (upon hire), LIC 500, LIC 610. The Notice of Site Visit was posted. 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. The director was provided a copy of their appeal right (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Continued on page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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: NMUSD COLLEGE PARK PRESCHOOL	FACILITY NUMBER: 304370182
	VISIT DATE: 08/29/2019

NARRATIVE

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A hard copy of Form LIC 311A, Records to be Maintained at the Facility was provided. LPA reminded coordinator of requirements of disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting. LPA reminded coordinator to contact Licensing Officer of the Day within 24 hours and complete the Unusual Incident Report (LIC 624) within 7 days. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf. Lead brochure was provided.
The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the updates. This report is to be on file and accessible for public review at the facility for at least 3 years. Exit interview was conducted.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

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