304370537-9-4-2019-06-CC-KDEI-BFPTZM-20190904151036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370537
Report Date: 09/04/2019
Date Signed: 09/04/2019 03:10:48 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:	HOLY FAMILY CATHEDRAL PRESCHOOL		FACILITY NUMBER:	304370537
ADMINISTRATOR:	DEUSENBERRY, JANET		FACILITY TYPE:	850
ADDRESS:	530 SOUTH GLASSELL		TELEPHONE:	(714) 538-6012
CITY:	ORANGE	STATE: CA	ZIP CODE:	92866
CAPACITY:	28	CENSUS: 24	DATE:	09/04/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Deusenberry Janet		TIME COMPLETED:	03:25 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), Ketki Desai conducted an unannounced three year required inspection of the facility on today's date. LPA Ketki Desai toured the facility with the director, (Deusenberry Janet) inside and outside. The Preschool sessions are held in 3 designated classrooms ( Room #1/ 2 and 3) Room # 1 and 2 has full day sessions from 7.50 AM to 2.50 PM Monday to Friday while Room # 3 has Morning and afternoon sessions. Morning sessions are held three days a week (M/W/F) from 7.50 am to 10.50 am while afternoon sessions are held Monday to Friday from 11.50 am to 2.50 PM. After school care is held in Classroom 1 from 3.00 pm to 5.45pm. (M-F) 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. Operating hours are 7.00 AM- 5.45 PM, Monday to Friday. 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 not kept on the premises. Children bring in their own lunch/ snacks / Milk or Juice from home, lunch boxes are placed in the cubby area, children also bring in their own water bottles, and water gallon containers with cups are available in each classroom,

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019

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: HOLY FAMILY CATHEDRAL PRESCHOOL	FACILITY NUMBER: 304370537
	VISIT DATE: 09/04/2019

NARRATIVE

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water bottles are also filled up if needed and water fountain also observed in the play yard. The children's bathrooms are clean and sanitary. Children in room #1 and 2 do nap during their time in the facility and the sleeping cots/ mats are stored appropriately. Children in room #3 do not nap. Linens are washed on a weekly basis by the parents and additional linens were observed.
Isolation area is in the Nurse's office and additional mat is available.

Facility also has conducted an emergency / Fire drill within the past month. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. The playground was completely fenced. The playground equipment appeared in safe condition. There is enough cushioning underneath climbing structures and/or play equipment to absorb falls and has enough shade.

Sign in/out procedure was reviewed for compliance. At least one staff member present possesses current CPR/First Aid certification, which expires 08/2021. Children's and staff files were reviewed and are in compliance.

The facility does provide Incident Medical Services. Currently there are no enrolled children receiving the services. Nurse on campus provides the required treatment and medications are stored in the Nurse's office.
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.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

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: HOLY FAMILY CATHEDRAL PRESCHOOL	FACILITY NUMBER: 304370537
	VISIT DATE: 09/04/2019

NARRATIVE

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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 was observed of the California Code of Regulations, Title 22, Division 12 at the time of the inspection.

Facility does receive notifications for quarterly updates from Child Care Advocate.

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

Exit interview was conducted. Report reviewed and discussed.
Notice of Site Visit was posted during the visit. The director was provided a copy of their appeal rights (LIC 9058 01/16) Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

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 $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC809 (FAS) - (06/04)

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