304370252-7-18-2019-06-CC-SHAS-BE7QJX-20190718121328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370252
Report Date: 07/18/2019
Date Signed: 07/18/2019 12:13:36 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:	SALVATION ARMY, TUSTIN RANCH-HENLEY YOUTH CTR, THE		FACILITY NUMBER:	304370252
ADMINISTRATOR:	BANKER, DIANE		FACILITY TYPE:	840
ADDRESS:	10200 PIONEER ROAD		TELEPHONE:	(714) 210-6050
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92782
CAPACITY:	75	CENSUS: 42	DATE:	07/18/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Diane Banker		TIME COMPLETED:	12:30 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 met with director, Diane Banker, for an annual visit. LPA toured the facility, including all activity/classroom areas, the isolation area, rest-rooms and outdoor play areas. LPA observed 42 school-age children (kindergarteners - children with 14 years old) with 5 staff including director, Diane Banker. 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. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. LPA observed all required forms to be posted. There are no children enrolled who require medication at this time. Some first aid materials were available. There are adequate toys and equipment available for children. LPA toured the yard area and the gym area where the children are at. The rest-rooms were observed to be in working order. The facility provides afternoon snack to all school-age children and the junior high children can purchase extra snack as needed.The program operates from M-F 6:30a.m.- 6:00p.m. Currently the program is running the summer day camp which operates 8am- 6pm. LPA reviewed the sign/in-sign/out sheet, children's and personnel records. Staff files were checked for health screenings, tuberculosis screening and education requirements. At least one staff member present today have current pediatric CPR and First Aid exp. 8/20 throughout the day. LPA reviewed staff and children's files, disaster drill log, as well as LIC 500 and children's roster. Director expressed that the program was interested in utilizing additional buildings on the property and would follow up in the future regarding an increase in capacity. LPA observed a tether ball stand outside on the playground that could potentially become a hazard. During inspection facility maintenance removed item from the area. This facility provides Incidental Medical Services – IMS. Director stated there are no children currently enrolled who requires IMS services. 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 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: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: SALVATION ARMY, TUSTIN RANCH-HENLEY YOUTH CTR, THE	FACILITY NUMBER: 304370252
	VISIT DATE: 07/18/2019

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Continued page 2
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

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

LPA advised director on utilizing LIC 9040 Children's roster.

Exit interview was conducted. 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. LPA informed the director of how to access regulations and forms from CCLD websites: www.ccld.ca.gov or Myccl.ca.gov and http://ccld.ca.gov/PG411.htm. This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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