304370358-5-3-2019-06-CC-SHAS-BBTSFQ-20190503135042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370358
Report Date: 05/03/2019
Date Signed: 05/03/2019 01:50:52 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:	TUSD/KINDERGARTEN READINESS ACADEMY-HEIDEMAN		FACILITY NUMBER:	304370358
ADMINISTRATOR:	TORRES, ANA		FACILITY TYPE:	850
ADDRESS:	15571 WILLIAMS STREET		TELEPHONE:	(714) 730-7521
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY:	24	CENSUS: 19	DATE:	05/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Lauralee Cabibi		TIME COMPLETED:	02:15 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	The purpose of this inspection was to conduct an Annual Evaluation of the facility. Licensing Program Analyst (LPA) S. Hawkins toured the facility inside and outside. The overall census observed was 3 preschool staff, and 19 preschool children. This facility is located in classroom #5 located at Heideman Elementary School. Director Lauralee Cabibi and Preschool Specialist Emily Daniel arrived during the inspection. 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. Sign in/out, 1^st aid/CPR, cleaning supplies storage, carbon monoxide detector, and drinking water were inspected. Facility met all posting requirements. The California Child Passenger Safety Law, License and Menus were posted by the entrance of the facility. Staff files and children's records were reviewed. The program operates from 8:30a.m.- 3:15p.m. (AM session 8:30 - 11:30am and PM session 12:15 - 3:15pm). All children receives a meal/lunch provided by the school district. The facility was clean, safe and in good repair at the time of the visit. All floors were clean and safe. The restrooms, equipment and furniture was in good repair and free of sharp edges. Disinfectant, cleaning solutions and other poisons were locked or made inaccessible to the children. Children's records were reviewed, and there was a separate, complete and current record for each child. Children have been signed in and out with legal signatures. Children's emergency information and admission's agreement were reviewed. Staff flies were reviewed, and educational background and CPR/Pediatric First Aid were present. There are no bodies of water or weapons present at the facility. This facility provides Incidental Medical Services (IMS), and a copy is on file with the Licensing Office. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: 05/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019

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: TUSD/KINDERGARTEN READINESS ACADEMY-HEIDEMAN	FACILITY NUMBER: 304370358
	VISIT DATE: 05/03/2019

NARRATIVE

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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

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.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative, and website give below:
English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Doucments/ChildCareProvSleepSPAN2011.pdf

An exit interview was completed. The director was provided a copy of their appeal rights (LIC 9058 ) 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. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 day will result in a Civil Penalty 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: 05/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2019

LIC809 (FAS) - (06/04)

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