304370673-7-19-2021-06-CC-KDEI-C53UED-20210719153057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370673
Report Date: 07/19/2021
Date Signed: 07/19/2021 03:31:03 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:	44	CENSUS:	DATE:	07/19/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Assistant Director: Ms. Zaragoza, Berenice		TIME COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Case Management Licensee initiated inspection for a change in capacity (Decrease) in the current site for the Infant program.

Facility currently is licensed for 44 infants in Room # 1,2,3,4 and 5.

Now facility is requesting a decrease in capacity by removing Room # 4 from Infant License, reducing the capacity to 32 infants (Birth to 2 years old) in room # 1,2 3 and 5. Room # 1 is the Napping room.

LPA met with Facility Assistant Director Ms. Zaragoza Berenice, who gave a tour of the Infant rooms.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair in the infant rooms.

Napping area has appropriate cribs for Infants. Changing station is within the arms reach of the sink, there is also one designated toilet in room # 3 for older infants along with potty chairs if needed. All the rooms were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. Playground is completely enclosed by a fence.

Outdoor activity area is supplied with age and size appropriate equipment including bikes. An adequate amount of cushioning material is in place under the equipment. Shade is provided by awnings and a Water pitcher and personnel water bottles are used for drinking water. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, and criminal records clearances/exemption transfer requests.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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: 07/19/2021

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Indoor measurements: Room # 2,3 and 5 is as follows

Infant room #5	19.42	15.92	309.17		309.17
Infant room #5	9.75	4.5	36.90		36.90
Infant Room #2	23.08	18.07	417.06	13.31	403.75
Infant Room # 3	21.17	18.5	391.65	0.00	391.65

Total Indoor capacity: 1141’46 divided by 35 = 32’61 (33 infants)

Playground is completely enclosed by a steel fence. Outdoor activity area is supplied with age and size appropriate infant outdoor play items.

Total outdoor activity area (Infant yard): Only occupies 8 Infants. Facility Director shall revise the outdoor play yard to meet the requirement.

Based on today's inspection facility has enough indoor space for the requested capacity of 32 infants in room # 2,3 and 5 but does not have enough outdoor space.
Facility shall add the needed outdoor space to accommodate the requested capacity for 32 infants at least 50 % outdoor space.

License with the new change in capacity shall be granted after the final review and remeasuring of the outdoor space. Approximate time for completion is 4 weeks.

Report was read to the Facility Assistant Director and appeal rights were provided.

Notice of site visit posted.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC809 (FAS) - (06/04)

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