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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370549
Report Date: 11/10/2020
Date Signed: 11/10/2020 11:01:57 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:SAUSD/CARVER ELEM. SCHOOL-KINDER READINESS PROG.FACILITY NUMBER:
304370549
ADMINISTRATOR:FERNANDEZ, ELENAFACILITY TYPE:
850
ADDRESS:1401 WEST SANTA ANA BLVD.TELEPHONE:
(714) 564-2000
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY:24CENSUS: 0DATE:
11/10/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ms. Veronica Berber (Early Learning Specialist) TIME COMPLETED:
11:15 AM
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A case management Licensee initiated inspection was conducted on this date by LPA Ketki Desai. The purpose for today’s inspection was to evaluate the facility for a room swap from A 29 to A 01 on Carver Elementary School campus under the Santa Anna Unified School District. The Licensee has submitted an application with a total capacity for 24 Preschool children (2-5) years old to Monday to Friday ( 8.00 am to 4.00 PM ) in two sessions. LPA met with Ms. Veronica Berber (Early Learning Specialist) who gave the tour of the new classroom/bathrooms and the play yard to be used by the children. There were no children present during today's inspection.

This is a 3 hour session program in the morning and afternoon. AM, Break- Fast will be provided by School District and both the sessions are served lunch in the classroom through the School district and Early Childhood Education Program. Evaluator reviewed Title 22 Sections 101227 and 101327 with the licensee who is ultimately responsible to provide adequate, nourishing food.
Classroom is adequately equipped with age and size appropriate furniture and equipment. Drinking water in the indoor activity space will be supplied by thermos (igloo) and disposable cups/ water fountain and personal water bottles.
The Isolation area is the Nurse's office located at the end of the hallway, there is a School Nurse and the Program Nurse for immediate assistance to a sick child.

Currently due to pandemic situation the parents are not allowed in the campus, so the children are dropped off at the main entrance in the parking area, where the children shall be received by the staff. Electronic sign in procedure in place. Covid precautions observed and Covid Posters are posted through the campus and class room.
The inside area was measured . Findings as follows:
Total indoor activity space: 33'5" X 24'58" = 823.43 divided by 35 = 23.53 ( 24 children)
823.43 square feet that accommodates 24 children.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020
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/CARVER ELEM. SCHOOL-KINDER READINESS PROG.
FACILITY NUMBER: 304370549
VISIT DATE: 11/10/2020
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Total sinks : 5 x 15= 75 / Total toilets: 5 x 15= 75

The bathrooms for ( Boys/ Girls )is located across the classroom and there is a Waiver in place to share the bathroom with Elementary school children. There are multiple bathrooms and sinks available on the school campus.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings .Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation.

Outdoor: Children shall walk through the hallway to access the play yard, which was observed to be completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment including climbing structure. There are adequate amount of cushioning material in place under the climbing equipment and swings.

Shade is provide by trees and water fountain provides drinking water.



There is a waiver in place to share the play yard with Elementary school children on file.

Fire clearance from the Fire Authority has been received and approved for requested capacity of 24 children.

Based on today’s measurement and the sink & toilet availability, center has enough activity space to support the requested capacity of 24 children.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

After a tour of the center, no deficiency was observed. File will be submitted for approval as of today.

Exit interview conducted. Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020
LIC809 (FAS) - (06/04)
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