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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370545
Report Date: 12/05/2019
Date Signed: 12/05/2019 02:32:10 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:SAUSD/GARFIELD ELEM. SCHOOL-KINDER READINESSFACILITY NUMBER:
304370545
ADMINISTRATOR:CORTES,ANGELINAFACILITY TYPE:
850
ADDRESS:850 BROWN STREETTELEPHONE:
(714) 972-5300
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY:44CENSUS: 25DATE:
12/05/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Laura Barnett, Early Learning SpecialistTIME COMPLETED:
03:00 PM
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A case management inspection was conducted at this facility by Licensing Program Analyst (LPA) Hawkins.
During todays inspection LPA toured the facility inside and outside and observed a total census of 25 preschool children with 5 preschool staff and 2 parent volunteers. 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.
LPA met with Laura Barnett, Early Learning Specialist and discussed the unusual incident report in which Child #1 accused Staff #1 of poking him on 10/22/19 (See Confidential Names List LIC 811). The facility representative Laura Barnett reported the alleged incident to Licensing on 11/7/19.

During investigation, 4 staff was interviewed, and information was gathered. Further investigation is required to determine if alleged incident occurred. Based on the interviews conducted on 12/5/19, and the information obtained, it was determined that staff did not report the unusual incident to the Department by telephone or fax within the Department's next working day and during its normal business hours. This poses a potential Safety risk to the children in care.

The facility was not in compliance and violation of the California Code of Regulations, Title 22, Division 12 Section 101212(d)(1)(c) was discussed and cited at the time of the visit. (See LIC 809-D for specific deficiencies).

An exit Interview was conducted and report reviewed. Representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. 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 HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
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 3
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/GARFIELD ELEM. SCHOOL-KINDER READINESS
FACILITY NUMBER: 304370545
VISIT DATE: 12/05/2019
NARRATIVE
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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/GARFIELD ELEM. SCHOOL-KINDER READINESS
FACILITY NUMBER: 304370545
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

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101212 (d)(1)(c) Reporting Requirements(d)Upon the occurrence, during the operation of the child care center of any of the events...telepohone or fax...(1)Events reported...(C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:
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Based on reports reviewed and interview on 12/5/19, staff did not report unusual incident to the Department by telephone or fax within the Department's next working day and during its normal business hours. This poses a potential Safety risk to the children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2019
LIC809 (FAS) - (06/04)
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