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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370547
Report Date: 02/04/2020
Date Signed: 02/04/2020 03:00:13 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/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAMFACILITY NUMBER:
304370547
ADMINISTRATOR:MEDRANO, PATRICIAFACILITY TYPE:
850
ADDRESS:1405 FRENCH STREETTELEPHONE:
(714) 564-2200
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY:48CENSUS: 29DATE:
02/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Laura Barnett, Early Childhood SpecialistTIME COMPLETED:
03:30 PM
NARRATIVE
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The purpose of this visit was to conduct a case management visit to the facility due to an incident that the facility representative reported to the department on 1/24/20. According to the self reported incident , a parent reported to the staff that a child reported that he was given a shot (immunization) and pushed roughly by a staff member. Licensing Program Analyst (LPA) Hawkins met with Lead Teacher, Neida Gonzalez at the time of the visit. LPA toured the facility inside and outside. Census was taken. There were a total of 29 preschool children with 5 staff in rooms 30 and 31. Room 30 children were observed to be napping upon arrival. One additional staff member returned to the class, and the Early Childhood Specialist, Laura Barnett arrived during LPA's visit. 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. (The staff are employees of Santa Ana Unified School District).

LPA interviewed 5 staff, 1 of whom works in the identified room of the allege incident (rm 30). LPA gathered children/staff rosters, and additional children/ staff records. Children in room 30 were not interviewed due to them napping. Due to insufficient information available at this time, the incident needs further investigation. Further interviews are required.
In the areas evaluated, no deficiencies were observed and cited today per CA Code of Regulations, Title 22, and Division 12.

Exit interview was conducted. Notice of Site Visit was posted during the visit. 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.The representative was provided a copy of their appeal right (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the updates. This report is to be on file and accessible for public review at the facility for at least 3 years.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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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