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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370540
Report Date: 03/22/2022
Date Signed: 03/22/2022 10:54:11 AM

Document Has Been Signed on 03/22/2022 10:54 AM - It Cannot Be Edited

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:SAUSD/WASHINGTON ELEMENTARYFACILITY NUMBER:
304370540
ADMINISTRATOR:PEREZ, MARIAMFACILITY TYPE:
850
ADDRESS:910 WEST ANAHURST PLACETELEPHONE:
(714) 445-5100
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 29DATE:
03/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ms. Berber, Veronica (Early Learning Specialist) TIME COMPLETED:
11:00 AM
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A Case Management announced Licensee initiated site inspection was conducted today by LPA Desai, Ketki. LPA met with Ms. Berber, Veronica (Early Learning Specialist) who gave a tour of the new classrooms.

The purpose of the inspection was to inspect and measure facility for room swapping from Room # 10 and 18 to new classrooms # 3 and 4 on the premises of Washington Elementary school under Santa Ana Unified School district.
The program shall continue to operate from: M-F 8:00am--4:00pm in room # 4 the full day program and Room # 3 shall operate in two part time sessions (8-11 am) and (12.30 to 3.30 PM).
Children in Full day session in room # 4 shall receive AM/PM snacks with Lunch and Napping is a part of the activity schedule. Facility uses cots during napping time. Linens are provided by the facility and children bring in their own blankets.
Children in Room # 3 (Part time) morning session shall receive an AM snack while afternoon session lunch shall be served.
There is no change in capacity requested. Licensee is seeking to provide care for 48 preschool children (2-5 years old) Facility is also following title 5.

Facility does have bathrooms adjoining the classrooms and there are additional bathrooms with sinks on the premises. There is a Waiver on file to share the school play yards and restrooms.

LPA toured the entire facility indoors & outdoors and the following measurements were taken:

Indoor: Total indoor activity space: 1675’90 divided by 35 = 47’88 (48 children)
There are 2 sinks and 1 toilet inside each classrooms and additional bathrooms are in the passage area which has age appropriate toilets and sinks along with changing table and a step stool. Approved waiver is on file.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SAUSD/WASHINGTON ELEMENTARY
FACILITY NUMBER: 304370540
VISIT DATE: 03/22/2022
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Outdoor activity yard was observed to have age appropriate climbing structures with safe fall absorbing cushion (form cushion) it has enough shade and is fenced completely on all the sides.

Center has a waiver to share playground with TK, Kindergarten children and Special aid children.

Based on today’s measurement and the sink & toilet availability, Center have enough activity space to support the requested capacity of 48 children in the two new classrooms.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water fountains are available for inside and outside, along with personal water bottles.
· Playground is enclosed by appropriate fence and climbing structures, bike trails and outdoor activities
· Adequate shade is provided by canopy and building structure.
Play yard is accessed from each classroom.
· Food is provided by the school cafeteria, brought into the classroom in an individual wrapping
If any additional snack is needed, it is brought in from the school cafeteria staff
· Sick children will temporarily rest in the Nurse’s office on the school premises.
. Staff bathroom is in the elementary office.
· Medication will be stored in the locked box in the file cabinet.
· First Aid kit is complete.

Fire clearance has been received and approved from Orange county Fire Authority approving the capacity of 48 children.
A license for 48 children age (2-5 years) in Room # 3 and 4 shall be issued after the final approval.

Licensee was notified about disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, and Never Shake a Baby.
Facility meets all licensing requirements and file will be submitted for approval as of today.

Exit interview was conducted and a copy of this report was provided to Ms. Berber Veronica (Early Learning Specialist) along with the Appeal rights. Notice of Site visit was posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022
LIC809 (FAS) - (06/04)
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