304370408-8-13-2021-06-CC-STOE-C5UNYM-20210813105257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370408
Report Date: 08/13/2021
Date Signed: 08/13/2021 10:53:03 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:	PACIFIC DRIVE ELEMENTRY SCHOOL		FACILITY NUMBER:	304370408
ADMINISTRATOR:	COSGROVE, MARILEE		FACILITY TYPE:	850
ADDRESS:	1501 W. VALENCIA DRIVE, #33		TELEPHONE:	(714) 447-7735
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92833
CAPACITY:	24	CENSUS: 0	DATE:	08/13/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Trang Lai and Linda Prieto		TIME COMPLETED:	11:10 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	An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence for the purpose of temporarily relocating to classroom #35, while classroom #33 is undergoing some renovations during the school year 2021-2022. The facility is currently licensed for 24 and is not requesting a capacity change. The facility is located on the Pacific Drive Elementary School campus. LPA Torrence met with Trang Lai, Director, Child Development Services and Linda Prieto, Supervisor, who guided analyst on a tour of the facility. The facility was closed for the summer; therefore, there were no children or staff present. Operations hours are Monday-Friday; the facility has two sessions: AM session: 8:00AM-11:00AM and PM session: 12:00PM-3:00PM; serving children ages 3-5 years old. In portable classroom: #35. Wavier on file for bathroom and playround. 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. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the front office, in the nurse’s office. There is also a bathroom in the office that will be used for the ill children. Medication will be stored in the classroom, in a locked cabinet. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. Children bring their own water bottles from home and the school provide water, if needed. First Aid supplies were inventoried. Sign in / sign out record meets regulation requirements. School provides breakfast for AM session and lunch for PM session. Facility pick up the food at the school cafeteria, located on campus. .

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

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: PACIFIC DRIVE ELEMENTRY SCHOOL	FACILITY NUMBER: 304370408
	VISIT DATE: 08/13/2021

NARRATIVE

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Indoor Activity Space Measurements:
Classroom #35: 39.06 x 23.01 = 898-53(encumbered)=845 sqft.
Total= 845 sqft. divided by 35 = 24 children

Total children toilets and sinks:
Toilets: 2 x 15 = 30 children
sinks: 3 x 15 = 45 children

Outdoor Activity Space Measurements for temporarily playground:
Preschool Playground: approximately 17,739 divided by 75= 236 children

Preschool children have a waiver to share elementary school playground; which has sufficient amount of square footage to accommodate the requested 24 children

Playground is completely enclosed. An adequate amount of cushioning material is in place under the equipment. Shade is provided by a mature tree. Drinking water is available by children bringing their water bottles from home and a water jug is available for refills.

Fire clearance approval letter on file and dated 08/13/2021, adding room #35 temporarily.

Facility provides Incidental Medical services.

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

A license will be issued for the capacity of 24.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director 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

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021

LIC809 (FAS) - (06/04)

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