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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371096
Report Date: 07/23/2019
Date Signed: 07/23/2019 02:58:40 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:ESTOCK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
304371096
ADMINISTRATOR:JOHNSON, MARIAFACILITY TYPE:
840
ADDRESS:14741 NORTH B. STREETTELEPHONE:
(714) 669-1320
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:202CENSUS: 54DATE:
07/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Maria JohnsonTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Hawkins toured the facility inside and outside. The overall census observed was 7 school-age staff, 54 school-age children, and 2 student volunteers. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility was clean, safe and in good repair at the time of the visit. All floors were clean and safe. The restrooms, equipment and furniture was in good repair and free of sharp edges. Disinfectant, cleaning solutions and other poisons were locked or made inaccessible to the children. Food storage, sign in/out, 1st aid/CPR, carbon monoxide detector, and drinking water were inspected. Menus were posted. Children's records were reviewed, and there was a separate, complete and current record for each child. Children have been signed in and out with legal signatures and had I.D and emergency information present in there files. Staff flies were reviewed, and educational background documents were present. Staff have current immunization’s. There are no bodies of water or weapons present at the facility. This facility provides Incidental Medical Services (IMS), and a copy is on file with the Licensing Office. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

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.

The facility representative was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182).
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
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: ESTOCK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 304371096
VISIT DATE: 07/23/2019
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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 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 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative, and website give below:
English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Doucments/ChildCareProvSleepSPAN2011.pdf

An exit interview was completed. The report was reviewed and discussed.The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

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 $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 day will result in a Civil Penalty of $100.00

Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Fire Drill Log
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2