304370262-10-29-2020-06-CC-KDEI-BUUS9H-20201029134047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370262
Report Date: 10/28/2020
Date Signed: 10/29/2020 01:40:55 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:	HBCSD-PRESCHOOL ACADEMY		FACILITY NUMBER:	304370262
ADMINISTRATOR:	RENEE POLK		FACILITY TYPE:	850
ADDRESS:	19231 HARDING LANE		TELEPHONE:	(714) 962-3348
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY:	72	CENSUS: 0	DATE:	10/28/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Administrator Ms, Wertheim Carolyn		TIME COMPLETED:	03:15 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	A case management Licensee initiated inspection was conducted on this date by LPA Ketki Desai. The purpose for today’s inspection was to evaluate the facility for a capacity increase by adding additional rooms. LPA met with director of ECE, Ms. Wertheim Carolyn There were no children present during today's inspection. Facility is currently licensed for 72 children and seeking to increase capacity to 75 children ages from 3 to 5 years of age, Monday through Friday, 8:30 AM to 4.00 PM. (Staff are present).The program will be adding 6 more rooms ( Room # 2,3,4,5,6,13 to the previously licensed 3 rooms, (Room # 1,7 and 11) Room # 8 is the designated new Early Childhood Development office. Per Licensee room # 11 is no longer in use. Since the Perry Elementary school is no longer in session on these premises. The facility shall continue to use the designated outdoor yard and the restrooms on the premises. The facility has enrollments serving children (3-5 years old) from 9am -1pm and it's a fee based program, and the state funded program (9.15 am to 12.15 pm) All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, and mat/cot were inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. (Page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

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: HBCSD-PRESCHOOL ACADEMY	FACILITY NUMBER: 304370262
	VISIT DATE: 10/28/2020

NARRATIVE

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First Aid supplies were inventoried. Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure. An adequate amount of cushioning material is in place under the equipment. Shade is provided by trees and awnings and a drinking fountain provides drinking water. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, and criminal records clearances/exemption transfer requests, SIDS and Never Shake a Baby complete.

All the 8 Preschool rooms were measured today:

Room # 13 = 30’92” x 28’92” = 869.16 – 34.50= 859.71 Sq. ft
Room # 7= 30’83”x 28’92” = 891.60 -14.6 =8.77.26 Sq. ft
Room 1 (Small area) = 5’33”x 17= 90’61”
Room 1(Big area) = 35’42”x 28’75” =1018’32”-14’34” =1,003’ 98”
Room 2(Small area) = 5’33” x 16’92”= 90’18”
Room 2 (Big area) = 36’08” x 28’33” = 1,022’15”-14’34” = 1,007’81”
Room 3(Small area) = 5’08” x 19’67” =99’92”
Room 3 (Big area) = 36’42” x 28’92” =1,053’27”-14’34” = 1038’93”
Room 4 = 30’92” x 28’92” = 894’21”-14’34” = 879’87”
Room 5= 30’83” x 28’83 = 888’83” -14’34” = 874’49”
Room 6= 30’83” x 28’92” = 891’60” -14’34” =877’26”

Total indoor capacity: 6696’04” divided by 35= 191.32

Total sinks= 15 x 15= 225
Total urinals (4) and (8 stalls) = 10 x15= 150 (page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

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: HBCSD-PRESCHOOL ACADEMY	FACILITY NUMBER: 304370262
	VISIT DATE: 10/28/2020

NARRATIVE

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Outdoor: Facility has enough outdoor space for the requested capacity of 75 children.

Fire clearance from the Fire Authority has been received on 10/15/20 and approved for requested capacity of 75 children.

Based on today’s measurement and the sink & toilet availability, center has enough activity space to support the requested capacity of 75 children.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

After a tour of the center, no deficiency was observed. File will be submitted for approval as of today.

Exit interview conducted. 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 it will result in civil penalties of $100. “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.”

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

LIC809 (FAS) - (06/04)

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