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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370972
Report Date: 07/17/2019
Date Signed: 07/17/2019 09:39:37 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:ANAHEIM ELEMENTARY SCHOOL DISTRICT ORANGE GROVEFACILITY NUMBER:
304370972
ADMINISTRATOR:JELINEK, VIVIANAFACILITY TYPE:
850
ADDRESS:1000 SOUTH HARBOR BLVD.TELEPHONE:
(714) 517-8968
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:96CENSUS: 0DATE:
07/17/2019
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Viviana Jelinek-School Readiness CoordinatorTIME COMPLETED:
09:30 AM
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A case management inspection was conducted today by Licensing Program Andrea Taylor to measure for capacity. The program is changing classrooms to K-6 and decreasing capacity to 24 children. There were no children present and an appointment had to be made in order to have access to the classroom. LPA toured the entire facility indoors & outdoors and the following measurements were taken:

Indoor:
Room #K-6: 1195 div. 35 = 34

Total indoor space= 1195 div 35= 34 children

Total children toilets and sinks:

2 toilets x 15 = children = 30
2 sinks x 15 = children = 30

Total Outdoor Activity: 17736 div. 75 = 236

Based on today’s measurement limiting factor is the toilets and sinks, the capacity is limited to 30 children.

The school age will share play ground with preschool on rotating basis. There is a waiver in place for sharing the play ground.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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: ANAHEIM ELEMENTARY SCHOOL DISTRICT ORANGE GROVE
FACILITY NUMBER: 304370972
VISIT DATE: 07/17/2019
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The following was observed:
· Classroom is adequately equipped with age and size appropriate furniture and equipment
· Water fountains available for inside & outside for drink.
· Playground is enclosed by appropriate fence.
· Outdoor activity area is supplied with age and size appropriate equipment.
· Adequate shade is provided by the patio area
· Equipped with refrigerator; food is prepared and delivered by Anaheim Union.
· The area located next to the entrance to the classroom and will temporarily serve as the isolation area for
ill children until parents arrive.
· First Aid kit is complete.
· Sign in/Sign out record was reviewed.

Exit interview was conducted and a copy of this report was provided to the program coordinator on this date.


The information regarding safe sleep has been provided to licensee on numerous previous occasions.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
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