304370947-9-17-2019-06-CC-DVAA-BG4VC9-20190917161846

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370947
Report Date: 09/17/2019
Date Signed: 09/17/2019 04:18:51 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:	SAUSD- JACKSON HEAD START		FACILITY NUMBER:	304370947
ADMINISTRATOR:	NGUYEN, THACH		FACILITY TYPE:	850
ADDRESS:	1143 NAKOMA DRIVE		TELEPHONE:	(714) 569-3599
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	51	CENSUS: 12	DATE:	09/17/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Thach Nguyen, Head Teacher		TIME COMPLETED:	04:45 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	An inspection was conducted at the facility by LPA Dean Valencia. The facility file was reviewed prior to this inspection being conducted. This is a Title 5 funded/regulated facility, and fingerprint clearance information is monitored and regulated by the Department of Education The facility has requested an increase in capacity, from 51 to 60. During today's inspection new rooms were evaluated and inspected to approve the changes. An approved Fire Inspection Request was received for the new rooms/capacity, on 9/11/19. Operating hours are 8am to 4pm, Mon-Fri. The facility operates in rooms 12, 13, and 14 on the campus of Jackson Elementary. The facility has part day and full day programs at this time, and is closed during the summer. The facility was toured inside and outside and the floor and yard plan were verified. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. There were 7 staff and 12 children present during the inspection. The facility appeared clean and orderly. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are not stored on site and none were observed. Children do not nap on site. Food is prepared on site; snacks and lunches are provided. Food prep areas appear clean and sanitary, food is properly stored. The facility has a monthly menu posted and is up to date. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary, and are shared with the school. A waiver is on file to share the restrooms. The facility has conducted an emergency drill within the past six months, and is documenting them. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. The playground is completely fenced and fencing is in good repair. The playground equipment appeared in safe condition, and the play area is free from hazards. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. There is a waiver on file to share the yard with the school campus. Sign in/out procedure was reviewed for compliance. Staff have proof of current pediatric CPR/First Aid certification, which expires 8/2020. Staff files were reviewed, and are within compliance. (continued on LIC809C)

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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: SAUSD- JACKSON HEAD START	FACILITY NUMBER: 304370947
	VISIT DATE: 09/17/2019

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During today's inspection the classrooms, restrooms, and outdoor play area were inspected. Rooms 12 and 13 measure 44 x 25 ft and room 14 measures 36 x 25 ft, totaling 3,100 sq ft = 88 children. The facility has sufficient indoor and outdoor space to accommodate the requested capacity of 60. There are 2 toilets/4 sinks available inside the classrooms, and there is also 6 toilets and 4 sinks available in a shared restroom nearby the classrooms.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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
Proof of immunization's against pertussis, influenza (or written declination), and measles for all employees/volunteers are on file and within compliance.
Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. The training certificates were reviewed and discussed with the director
A pamphlet of Effects of Lead Exposure was provided for care provider and discussed.
Exit interview was conducted, and report, deficiencies, and advisory notes was reviewed and discussed. Notice of Site Visit was posted during the visit. The 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 per day. The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional manager, address is above on the report. The facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. and accessibility and access to the website was discussed with the care provider. This report is to be on file and accessible for public review at the facility for at least 3 years.

The facility will be granted the increase capacity as of today's date, 9/17/19, pending a managerial approval.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

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