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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371053
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:35:41 AM

Document Has Been Signed on 01/15/2025 11:35 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:OUSD-PALMYRA PRESCHOOLFACILITY NUMBER:
304371053
ADMINISTRATOR/
DIRECTOR:
YBARRA, RENEEFACILITY TYPE:
850
ADDRESS:1325 E. PALMYRATELEPHONE:
(714) 628-5557
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 21DATE:
01/15/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Gioia, Kendy (Ealy Learning Specialist)TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 1/15/2025, Licensing Program Analyst (LPA) Vivian Trinh conducted an unannounced Required – Annual inspection assisted. LPA and the Early Learning Specialist Gioia, Kendy toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 21 preschool children supervised by 3 staff members. During the inspection, it was determined the facility is operating within its licensed capacity and within compliance of staff-to-child ratios. Facility hours are 8:00a.m.- 3:00p.m., Monday through Friday

INDOOR INSPECTION. The LPA inspected the indoor areas and areas accessible to children at the time of the visit. The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. A record review shows that the last fired rill was documented on 12/12/2024. The Early Learning Specialist stated that there are no firearms or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to children in care. No poisons or other items that could pose a danger to children were observed during the inspection. The facility provides age-appropriate toys, play equipment, and materials for the children served.

ON-SITE FOOD PREPARATION: Food is prepared on-site; lunch and snacks are provided, food prep areas were clean and sanitary, and food was properly stored. Menus are posted where they can be reviewed by parents. Drinking water is available to children indoors children bring their own water bottles from home with the child’s name on them, and also by water bottles and filtered water. The LPA observed that the facility’s floors, equipment, furniture, and children’s bathrooms were clean, in good repair, and free of sharp edges. The facility meets all posting requirements.

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Nguyen K TranTELEPHONE: (714) 658-6048
Vivian TrinhTELEPHONE: (949) 466-1624
DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUSD-PALMYRA PRESCHOOL
FACILITY NUMBER: 304371053
VISIT DATE: 01/15/2025
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OUTDOOR INSPECTION. The outdoor activity space was inspected for compliance. The playground is enclosed by a fence at least four feet in height and is in good repair. The surface of the outdoor activity space is maintained and free of hazards. The cushioning material around outdoor play equipment and other similar equipment appeared to be enough to absorb falls. Drinking water in the outdoor activity space is provided by water bottles. The outdoor equipment and toys are in good repair and free of sharp edges. There are no bodies of water present at the facility. The inspected outdoor facility grounds are safe, sanitary and in good repair.

PERSONNEL RECORDS. Staff files were reviewed for staff present during the facility inspection on this date, 3 out of 3 staff members files were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a child day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff members were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training and to renew the training every two years. Staff files were reviewed for compliance. At least one staff member present has current EMSA-approved Pediatric CPR/First Aid certifications.

CHILDREN’S RECORDS: Children's records were reviewed for compliance present during the facility inspection on this date, 5 out of 5 children files were reviewed Each child has a separate, complete, and current record. Sign in/out procedure was reviewed for compliance. Transportation is NOT or offered to children.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication, and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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SUPERVISOR'S NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR NAME: Vivian TrinhTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUSD-PALMYRA PRESCHOOL
FACILITY NUMBER: 304371053
VISIT DATE: 01/15/2025
NARRATIVE
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The Early Learning Specialist was informed that Licensing Quarterly Updates are available at www.cdss.ca.gov Director 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 or at www.cdss.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 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 California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

LEAD TESTING: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. The Early Learning Specialist submitted LIC 9275 and LIC 9276. Water Board website shows no lead exceedance.

CRIMINAL RECORD CLEARANCE: The Early Learning Specialist understands 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 the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

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SUPERVISOR'S NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR NAME: Vivian TrinhTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUSD-PALMYRA PRESCHOOL
FACILITY NUMBER: 304371053
VISIT DATE: 01/15/2025
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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.

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.

Appeal Rights and deficiencies were discussed. The Early Learning Specialist 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. Exit interview was conducted and the report was reviewed with the director. Exit interview conducted and report was reviewed with the Early Learning Specialist Kendy Gioia.


End of the Report.
SUPERVISOR'S NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR NAME: Vivian TrinhTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4