304370587-6-24-2022-06-CC-KDEI-CFPNE6-20220624102327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370587
Report Date: 06/24/2022
Date Signed: 06/24/2022 10:23:35 AM

Document Has Been Signed on 06/24/2022 10:23 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/MARTIN ELEMENTARY SCHOOL		FACILITY NUMBER:	304370587
ADMINISTRATOR:	RAMOS, MARCELA		FACILITY TYPE:	850
ADDRESS:	939 WEST WILSHIRE		TELEPHONE:	(714) 431-7200
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92707
CAPACITY:	24	CENSUS: 0	DATE:	06/24/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ms. Berber, Veronica (Early Education Specialist)		TIME COMPLETED:	10:30 AM

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	An announced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Desai, Ketki for the purpose of swapping one classroom. The facility is not requesting a change in capacity. The facility is currently licensed for 24 preschool children in room # 42 only . Currently the facility has two half day sessions :AM session 8:00-11:00 and PM session from 12 noon to 3.00 PM , Monday- Friday serving children ages 2-5 years old LPA Desai, Ketki met with Early learning Specialist : Ms Berber, Veronica who guided analyst on a tour of the facility. The facility is located on the Martin Elementary School campus, there were no children present on the site due to Summer break. . Facility has a Waiver on file to share the elementary school bathrooms and the kindergarten playground. Now facility is requesting to swap the room to a new classroom # 22 with a full day session only from 8.00 am to 4.00 PM Monday to Friday serving preschool age children (2-5 years old) 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. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the nurse’s office, located across the classroom and there is also a bathroom located in this area for the ill children to use. Medication will be stored in the classroom, located in a top cabinet. Incidental Medical services are provided. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. (1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

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: SAUSD/MARTIN ELEMENTARY SCHOOL	FACILITY NUMBER: 304370587
	VISIT DATE: 06/24/2022

NARRATIVE

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The facility provides water inside/outside by a water jug and disposal cups and children bring their own water bottles from home labeled with their names. First Aid supplies were inventoried.
Facility shall now provide Breakfast/Lunch and PM snacks and it shall be delivered from the School cafeteria under the Santa Ana Unified School district.

The new classroom is located facing the main school office and the exit is across it. The school campus is completely fenced and has only one entry point. All the children drop off and pick up shall be at the main gate, Teachers shall receive the children at the entry point and Electronic sign in shall be completed.

Room # 22 will be a full day program from 8.00 am to 4.00 PM and children shall be offered: Breakfast/ Lunch and PM snack . Napping will be in this classroom. Children shall nap on the cots, linens and blankets shall be provided by the center and washed by the parents on a weekly basis.

Following was observed in the new classroom #22
1) Age appropriate furniture and activities including Educational / Arts & Crafts items.
2) Room is well ventilated with proper lighting and shade.
3) There is a working Smoke detector / Carbon Monoxide detectors and Fire Extinguisher.
4) There is one sink in the classrooms and additional sinks and toilets are present at the end of the classroom and additional one on the school premises.
5) Parent drop off - pick up: Designated front fenced gate on Wilshire Ave ,during drop off and pick up time, teachers shall be at the gate to receive and hand over the child. Electronic sign in is done. Program is using Kinder-sign application .

Preschool rooms were measured today: Indoor activity space: 825'60 sq ft divided by 35 = 23'59 (24)
Facility has sufficient space to accommodate 24 preschool age children as requested.

Total sinks : 5 x 15= 75 children Toilets: 7 x 15= 105 children

There are designated toilets and sinks for the preschool children just outside the classroom. Facility has a Waiver on file to use the additional school restrooms on the premises. (2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

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: SAUSD/MARTIN ELEMENTARY SCHOOL	FACILITY NUMBER: 304370587
	VISIT DATE: 06/24/2022

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Playground is 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. Play yard is in front of the office facing Wilshire Ave

Shade is provide by trees and water fountain provides drinking water.
There is a Waiver on file to share the play yards with Kindergarten and Special aid children.

Fire clearance approval letter on file and dated 06/06/2022, is on file for the new room # 22

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

A new License shall be issued upon management approval

24 Preschool age children (2-5 years) old in Room # 22
Full day session only Monday to Friday: 8.00 am to 4.00 PM.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. 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. .

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

LIC809 (FAS) - (06/04)

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