304371042-5-8-2023-06-CC-PRIS-CRMNVZ-20230508104847

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371042
Report Date: 05/08/2023
Date Signed: 05/08/2023 10:49:36 AM

Document Has Been Signed on 05/08/2023 10:49 AM - It Cannot Be Edited

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/FREMONT ELEMENTARY		FACILITY NUMBER:	304371042
ADMINISTRATOR:	SIDERS, GRISELDA		FACILITY TYPE:	850
ADDRESS:	1930 W. 10TH STREET		TELEPHONE:	(714) 431-7542
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92703
CAPACITY:	24	CENSUS: 18	DATE:	05/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Ms. Denise Maldonado Teacher & Aldo Aceves		TIME COMPLETED:	11:15 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) P Rivas conducted an unannounced annual inspection and was met by Lead Teacher Denise Maldonado. LPA and Ms. Rosete toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken and the overall census observed was 3 preschool staff and 18 preschool children. Aldo Aceves, Early Learning Specialist arrived and continued to assist LPA. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 8:00AM - 4:00 PM ., Monday through Friday. The program provided a full and half day sessions. The room that is licensed is Room 17. The bathrooms have clear designation for pre-school use in boys and girls bathroom. A review of the Facility Personnel Report Summary via Guardian conducted indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. Facility staff are School District Employees and clearances are completed via School District. Mr. Aceves was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Food is prepared on site in the school cafeteria; Breakfast, lunch and snack are provided from the school district. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by paper cups and gallon water. Page 1 of 4

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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/FREMONT ELEMENTARY	FACILITY NUMBER: 304371042
	VISIT DATE: 05/08/2023

NARRATIVE

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The children's bathroom is clean and sanitary. Partial Children do nap at facility. Parents take blankets and sheets home weekly or as needed to launder. Facility does have extra sheets/blankets. The facility has conducted an emergency drill within the past 6 months. The facility has a working carbon monoxide detector and fire extinguisher(serviced 07/22). Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material ( turf commercially produced for the purpose) around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by water gallons with disposable cups. Mr. Aceves stated that facility had lead testing completed on 12/23/22 and levels were within compliance. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Staff files were reviewed for staff present during the facility inspection on this date, 03 out of 03 staff files were reviewed. Health screening and immunization's as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 states, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed child care providers, administrators, or employees of a licensed child day care facility to complete the mandated reporter training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 07/23.
Children's records were reviewed, and there was a separate, complete and current record for each child. 05 of 05 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (emergency sheet) and a medical assessment.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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/FREMONT ELEMENTARY	FACILITY NUMBER: 304371042
	VISIT DATE: 05/08/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. As of today no children are taking medication. For
IMS information see PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child Care Homes 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

Mr. Aceves was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov director is receiving Quarterly Update via the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The director 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 California Department of Social Services Lead Information Brochure was explained and provided to the facility representative. Facility Director does/does not have lead training Certificate.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

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/FREMONT ELEMENTARY	FACILITY NUMBER: 304371042
	VISIT DATE: 05/08/2023

NARRATIVE

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Exit interview conducted and report was reviewed with Aldo Aceves. , Early Learning Specialist. Appeal Rights and were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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