304370673-8-2-2019-06-CC-SHAS-BEP25D-20190802170522

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370673
Report Date: 08/02/2019
Date Signed: 08/02/2019 05:05:32 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:	PAGE SCHOOL OF COSTA MESA		FACILITY NUMBER:	304370673
ADMINISTRATOR:	DICKSON, KRISTIN		FACILITY TYPE:	830
ADDRESS:	657 VICTORIA STREET		TELEPHONE:	(949) 515-1700
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	32	CENSUS: 26	DATE:	08/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Bernice Thorin		TIME COMPLETED:	05:30 PM

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	The purpose of this visit was to conduct an annual visit of the facility and provide an increase in capacity initiated by licensee. Licensing Program Analyst (LPA) Hawkins met with assistant director, Bernice Thorin and toured the facility inside and outside. The director, Kristin Dickson was not present upon arrival but arrived during the inspection. At the time of the visit there were a total 26 infants and toddlers with 9 staff observed in rooms 1, 2, 4, and 5. Three infants were napping in Room #1 and 2 infants napping in room 5. 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. Medication, food storage, sign in/out, 1^st aid/CPR, cleaning supplies storage, Carbon Monoxide, and drinking water were inspected. Posting requirements were reviewed. Staff records and children's files were reviewed at this visit. The facility provides Incidental Medical Services-IMS. Assistant director reports that there are no children enrolled who needs services. For IMS information see Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800)514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/child qanda.htm. The facility is currently licensed for 32 infant children in classrooms (1,2,4,5) The facility has requested to increase the capacity to 44 infant children by adding Room #3 to the infant/toddler program. Applicant has requested to provide care and supervision for 44 infants and toddlers in rooms 1, 2, 3, 4, and 5 ages birth to 24 months old. Classrooms are adequately equipped with age and size appropriate furniture and equipment. continue on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019

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: PAGE SCHOOL OF COSTA MESA	FACILITY NUMBER: 304370673
	VISIT DATE: 08/02/2019

NARRATIVE

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The inside area was measured in the case the measurements are needed. Findings as follows:
Total indoor activity space for rooms # 3, 4, and 5, are approximately 1085 square feet.
The inside activity area was measured and the findings are as follows:
1100 sqft divided by 35 = 32 children
440 sqft divided by 35 = 12 children
Room 1 and 2 was measured that was approximately 440 square feet that accommodate 12 infants and toddlers. The crib room in room 1 was subtracted from the total measurement of this additional room.

There is one sink in room #3, one toilet and one sink in room # 4 and 2 sinks in room # 5. There are 12 toilets, 12 sinks and two urinals in the whole child care facility.
Playground is completely enclosed by a fence. The total outdoor space is approximately 7200 square feet that accommodate the total capacity for infant/toddler and preschool program. There is a grass area close to the infant/toddler room specified for the outdoor space for infants and toddlers.
Shade is provide by trees.

Upon review and approval of a licensing manager a license will be issued for the capacity of 44 children for preschool program for rooms # 1,2,3,4, and 5.
(Per fire Department, room 4 for 8 children, room 5 for 12 children and room 1 & 2 for 12 children)

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

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019

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: PAGE SCHOOL OF COSTA MESA	FACILITY NUMBER: 304370673
	VISIT DATE: 08/02/2019

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The facility representative was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm. California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The following website link for infant's safe sleep information in English and Spanish was given. www.cdph.ca.gov/programs/sids/documents/sidschildcaresafesleep.pdf
In Spanish www.cdph.ca.gov/programs/sids/documents/childcareprovsleepspan2011.pdf
Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided.
A copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org was given to the facility representative.

The report/appeal rights were reviewed and discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

The Notice of Site Visit was posted. Assistant 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. The (DIRECTOR/FACILITY REPRESENTATIVE/LICENSEE) was provided a copy of their appeal right (LIC 9058) and their signature on this form acknowledges receipt of these rights. Exit interview was conducted.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019

LIC809 (FAS) - (06/04)

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