304370789-9-11-2019-06-CC-SHAS-BFWPDR-20190911111357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370789
Report Date: 09/11/2019
Date Signed: 09/11/2019 11:14:05 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:	HANDS TOGETHER		FACILITY NUMBER:	304370789
ADMINISTRATOR:	CHAVEZ, KARINA		FACILITY TYPE:	830
ADDRESS:	201 E. CIVIC CENTER DRIVE		TELEPHONE:	(714) 479-0294
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92701
CAPACITY:	9	CENSUS: 4	DATE:	09/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Karina Chavez		TIME COMPLETED:	11:30 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	Licensing Program Analyst (LPA) Hawkins met with the director, Karina Chavez, for an annual inspection of the facility. LPA toured the facility, including all activity/classroom areas, the isolation area, rest-rooms and outdoor play areas.The program operates from 6:30 A.M.- 6:30 P.M. LPA observed 4 infants (1 sleeping) and 3 infant staff including the director. 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. LPA reviewed care and supervision of children, staffing ratios, health related services including first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. LPA also observed needs and service plans/feeding plans for each child which are updated quarterly. LPA observed all required forms to be posted. There are no children on medication at this time. Some first aid materials were available. There are adequate toys and equipment available for children. LPA checked the changing tables and sleeping area of infants and toddlers. Infant napping area have cribs and beddings that met regulations. Older infant have cots with beddings separating from each other. The facility has working smoke and carbon monoxide detectors. The center provides breakfast/lunch/snack and menus were posted in the facility. Parents provide preferred individual formula. Center has an updated fire drill log. LPA reviewed the sign/in-sign/out sheet, children's and personnel records. At least one staff member present today have current Pediatric CPR and First Aid (exp. 6/29/20) throughout the day. LPA reviewed staff and children's files as well as LIC500 and children's roster. Staff files were reviewed for educational requirements, mandated reporter training, and immunization records. Children files were reviewed for immunizations, LIC 700 identification/emergency contact forms; medical assessment, and parents rights LIC 995. All children and staff files were found to complete and in compliance. Continued on page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

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: HANDS TOGETHER	FACILITY NUMBER: 304370789
	VISIT DATE: 09/11/2019

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This facility provides Incidental Medical Services – IMS. Director reports that no child is currently receiving IMS 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) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

The facility representative was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov The facility representative may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were reviewed. The facility representative was informed, and website given, about the 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
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was observed in the facility, and website given below:
English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Doucments/ChildCareProvSleepSPAN2011.pdf

Exit interview was conducted. The 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 will result in civil penalties of $100. Appeal rights provided and explained if violation was issues. The director/licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene Hawkins	TELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019

LIC809 (FAS) - (06/04)

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