<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370673
Report Date: 11/18/2021
Date Signed: 11/18/2021 04:46:39 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 MESAFACILITY NUMBER:
304370673
ADMINISTRATOR:DICKSON, KRISTINFACILITY TYPE:
830
ADDRESS:657 VICTORIA STREETTELEPHONE:
(949) 515-1700
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:44CENSUS: 20DATE:
11/18/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator Ms. Dickson, KristinTIME COMPLETED:
05:00 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
Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Licensee initiated inspection at the above site.
This is a follow-up inspection, earlier inspection was conducted on 7/19/21 to make the requested changes to the Infant License.
During the inspection on 7/19/21, the infants rooms were measured. Facility has requested a decrease in the capacity by removing Room # 4 from Infant License, to 32 infants (Birth to 2 years old) in room # 1,2 3 and 5. Room # 1 is the Napping room.

The measured rooms were as follows
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)



Facility now has added an additional play yard for the older infants.

The new Infant yard is in front of the former yard. They new Infant yard is completely fenced with concrete and artificial grass flooring, shade is provided by a sail canopy. There are age appropriate toys arranged for the older infants.
New infant yard was measured on today's inspection.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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: PAGE SCHOOL OF COSTA MESA
FACILITY NUMBER: 304370673
VISIT DATE: 11/18/2021
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
26
27
28
29
30
31
32
Out door yard measurements

Back space
12.42
8.83
109.67
109.67
Front Space
22.42
22.08
495.03
495.03
New Yard 40 25.33 1,013.2 1,013.2

Total Outdoor yard : 1,617'9 divided 75 = 21.57 (22 Infants)

Based on today's inspection facility has enough indoor space for the requested capacity of 32 infants in room # 2,3 and 5 .
Facility has added the additional play yard and a Waiver shall be requested for a rotating schedule in-between three Infant rooms.

License with the new change in capacity shall be granted after the final review

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

Notice of site visit posted.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2