304370362-11-20-2019-06-CC-SHAS-BJ4QAD-20191120105945

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370362
Report Date: 11/20/2019
Date Signed: 11/20/2019 10:59:53 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 PAULARINO PRESCHOOL		FACILITY NUMBER:	304370362
ADMINISTRATOR:	HERNANDEZ, ANA		FACILITY TYPE:	850
ADDRESS:	1060 PAULARINO AVENUE		TELEPHONE:	(714) 424-7950
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	24	CENSUS: 22	DATE:	11/20/2019
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Michelle Oneill		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	Licensed Program Analyst (LPA) Hawkins met with Ana Hernandez, Site Director and the purpose of the Continuation Annual inspection of the facility was relayed. During the inspection Early Childhood Coordinator Michelle Oneill arrived to the facility to provide assistance. The preschool is located on the campus of Paularino Elementary School. Newport Mesa Unified School District manages the review for all staff or individuals who require caregiver background checks and that each staff/volunteer have received a criminal record clearance or exemption and a child abuse index clearance. Morning preschool hours are from 8:00 AM to 11:00 AM and the afternoon session is from 11:45 AM to 2:45 PM Monday thru Friday. Census was taken and LPA observed 22 preschool children with 3 staff members. 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 items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are kept locked in the janitors closet. Children have the option to bring food from home or to eat breakfast or lunch prepared by the school cafeteria. Food prep areas appear clean and sanitary. Food is properly stored and the kitchen appears free from hazards. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's restrooms were clean. Children do not nap at the center. The facility has conducted an emergency drill within the past six months and the last one occurred on 10/17/2019. The facility has a working smoke detector, carbon monoxide detector and a fire extinguisher. The playground was completely fenced. The playground equipment appeared in good condition. There appears to be sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. Sign in/out book was reviewed for authorized representative signature and documented time of drop off and/or pick up. At least one staff member present possesses current CPR/First Aid certifications, which expires 8/21/21. A sample of children’s files were reviewed for admission's agreement. A sample of staff files were reviewed for educational background and mandated reporter certificate. 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: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

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 PAULARINO PRESCHOOL	FACILITY NUMBER: 304370362
	VISIT DATE: 11/20/2019

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Coordinator provided the updated documents during today's inspection:
- Personnel Report (LIC 500)
- Fire Drill Log

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

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.

Licensee was advised on how to receive notifications for quarterly updates and was provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. Licensee was informed of where to access regulations and forms from CCLD website at: www.ccld.ca.gov
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was reviewed with representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Licensee was provided with information on how to access the E-Learning Modules available at https://ccld.childcarevideos.org

Exit interview was conducted. Report read out loud, reviewed and discussed. Notice of Site Visit was posted. 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. 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.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019

LIC809 (FAS) - (06/04)

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