304371133-10-8-2024-06-CC-AFCN-D9UPY9-20241008114334

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371133
Report Date: 10/08/2024
Date Signed: 10/08/2024 11:43:51 AM

Document Has Been Signed on 10/08/2024 11:43 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:	SAUSD/JEFFERSON ELEMENTARY-STATE PRESCHOOL PROGRA		FACILITY NUMBER:	304371133
ADMINISTRATOR:	SOSA, MARIA		FACILITY TYPE:	850
ADDRESS:	1522 WEST ADAMS STREET		TELEPHONE:	(714) 285-3782
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	48	CENSUS: 33	DATE:	10/08/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Early Learning Specialist Veronica Berber		TIME COMPLETED:	12:00 PM

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	On 10/08/24 at 9:48am, Licensing Program Analyst (LPA), Anna Chan conducted an unannounced onsite inspection for the purpose of an Annual Random Visit. LPA met with Preschool Teacher Maria Sosa and toured the facility inside and outside and the floor and yard plan were verified. Census was taken. The overall census observed was 33 preschool children and 6 staff. Children were having indoor activities when LPA arrived. Early Learning Specialists Aldo Aceves and Veronica Berber arrived at 10:45am to continue with the inspection. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. The Preschool Program has full day and part day schedules, Part Day hours are 8:00a.m.- 11:00a.m. and 1:00pm – 4:00pm, Monday through Friday. And Full day hours are 8:00am-4:00pm. The facility is located inside Jefferson Elementary School. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Menus are posted where it can be seen by parents in the classrooms. Allergy list of children are also placed in a cupboard in each classroom. Water is provided by purified water bottles and sports bottles with children’s name on it. Food is provided by the Santa Ana Unified School District. Full day children nap at the facility. Beddings are stored individually. Beddings are brought home for washing weekly. The facility conducted an emergency drill on 09/17/24. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility. Page 1 of 3

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/JEFFERSON ELEMENTARY-STATE PRESCHOOL PROGRA	FACILITY NUMBER: 304371133
	VISIT DATE: 10/08/2024

NARRATIVE

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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 playground has a turf grass surfacing and wood chips around the climbing structure which appears to be enough to absorb falls. The facility shares playground with the Elementary School. Drinking water in the outdoor activity space is provided purified bottled water and sports bottled with the children’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water at the premises.

5 Staff files were reviewed for the facility inspection on this date. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 (a)(1) 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 the facility were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete 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 09/2025.

5 Children's records were reviewed, and there was a separate, complete, and current record for each child. Sign in/out procedure through Care Connect, each child representative have their own pin. In the areas reviewed the children’s files were found to be in full compliance.

CCC COMPLETED TESTING AND HAS NO LEAD EXCEEDANCES: 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.

The facility has done Lead Test on December 28, 2022, with no exceedance.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: SAUSD/JEFFERSON ELEMENTARY-STATE PRESCHOOL PROGRA	FACILITY NUMBER: 304371133
	VISIT DATE: 10/08/2024

NARRATIVE

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Currently, there are medications in the facility. 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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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.

An Inspection and exit interview were completed with Early Learning Specialist Veronica Berber. The report was reviewed and discussed. Appeal Rights was 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.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC809 (FAS) - (06/04)

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