304371132-8-12-2021-06-CC-STOE-C5TMVA-20210812095624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371132
Report Date: 08/12/2021
Date Signed: 08/12/2021 09:56:30 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:	SAUSD/KING ELEMENTARY		FACILITY NUMBER:	304371132
ADMINISTRATOR:	RODRIGUEZ, OLGA		FACILITY TYPE:	850
ADDRESS:	1001 SOUTH GRAHAM LANE		TELEPHONE:	(714) 972-6000
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92703
CAPACITY:	48	CENSUS: 0	DATE:	08/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Veronica Berber-Aceves, Early Learning Specialist		TIME COMPLETED:	10:00 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	An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence for the purpose of swapping two classrooms. The facility has requested to swap licensed classrooms: #4 and K-3 with classrooms K-311 and K-312. The facility is currently licensed for 48 and is not requesting a capacity change. The facility is located on the Santa Ana School District, King Elementary School campus. LPA Torrence met with Veronica Berber-Aceves, Early Learning Specialist, who guided analyst on a tour of the facility. The facility was closed for the summer; therefore, there were no children or staff present. Operations hours are Monday-Friday; the facility has a full day program; hours of operation; 8:00 a.m.-4:00 p.m. and half day program with two sessions; AM session; 8:00 a.m.-11:00 a.m. and PM session; 12:30 p.m. -3:30 p.m.; serving children ages 2-5 years old. In classrooms: K-311 and K-312. Waiver for shared playground and restrooms on file. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the front office, in the nurse’s office. There is also a bathroom in the office that will be used for the ill children. Medication will be stored in the classroom, in a locked file cabinet. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. Children bring their own water bottles from home and the school provide water, if needed. First Aid supplies were inventoried. Sign in / sign out record meets regulation requirements. School provides breakfast, lunch, and snack for full day program and lunch for half day program. Facility pick up the food at the school cafeteria, located on campus. Continue next page (1 of 2).

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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/KING ELEMENTARY	FACILITY NUMBER: 304371132
	VISIT DATE: 08/12/2021

NARRATIVE

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Indoor Activity Space Measurements:
Classroom #K-311: 38.08 x 27.00= 1,028.00 sqft.
Classroom #K-312: 38.08 x 27.00= 1,028.00 sqft.-
Total= 2,056 sqft. divided by 35 = 58 children

Total children toilets and sinks:
Toilets: 5 x 15 = 75 children
sinks: 10 x 15 = 150 children

Outdoor Activity Space Measurements:
Preschool children have a waiver to share elementary school playground; which has sufficient amount of square footage to accommodate the requested 48 children

Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment. An adequate amount of cushioning material is in place under the equipment. Shade is provided by a tent structure. Drinking water is available by children bringing their water bottles from home and a water jug is available for refills.

Fire clearance approval letter on file and dated 06/21/2021, adding rooms K-311 and K-312.

Facility provides Incidental Medical services.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

A license will be issued for the capacity of 48.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director 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.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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