304371138-12-9-2020-06-CC-KDEI-BW5RF3-20201209115824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371138
Report Date: 12/04/2020
Date Signed: 12/09/2020 11:58:29 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:	TAMURA CDC PRESCHOOL		FACILITY NUMBER:	304371138
ADMINISTRATOR:	MONA GREEN		FACILITY TYPE:	850
ADDRESS:	17340 SANTA SUZANNE ST		TELEPHONE:	(714) 962-4099
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	24	CENSUS: 12	DATE:	12/04/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Director Ms. Green Mona		TIME COMPLETED:	11:00 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	A Case Management site inspection was conducted today by LPA Ketki Desai to inspect and measure facility for room swapping from room # 30 to one new room # 31, which is adjacent to the main gate in front of the second parking lot. The program shall continue to operate from: M-F 7:00am--6:00pm in room #31 at Tamura Elementary School. Licensee is seeking to provide care for 24 preschool children. LPA met with director Ms. Green, Mona and toured the entire facility indoors & outdoors and the following measurements were taken: Indoor measurements: Classroom #31: 39’ x 23’ = 897’- 56.53 = 844.44 divided by 35 = 24.13 There are 2 sinks and 1 toilet inside of room # 31 Center has submitted a waiver request for children to share restroom with elementary children. Outdoor activity yard was observed to have age appropriate climbing structures with safe fall absorbing cushion underneath (wooden chips and form cushion) it has sufficient shade and is fenced completely on all the sides. Center has submitted a waiver request to share playground with Kindergarten children. Base on today’s measurement and the sink & toilet availability, Center have enough activity space to support to the requested capacity of 24 children.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

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: TAMURA CDC PRESCHOOL	FACILITY NUMBER: 304371138
	VISIT DATE: 12/04/2020

NARRATIVE

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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water fountains are available for inside and outside.
· Playground is enclosed by appropriate fence and shared with Kindergarten children.
· Adequate shade is provided by trees.
· Food preparation area is equipped with refrigerator; sink with hot and cold running water: storage area; adequate amount of food supplies.
· Ill children will temporarily rest next to teacher's desk in the classroom and use the bathroom located outside the classroom.
. Staff bathroom is in the elementary office.
· Medication will be stored in the locked box in the file cabinet.
· First Aid kit is complete.

Licensee was notified about disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, and Never Shake a Baby.

Fire clearance has been received from Fountain Valley Fire Department and granted approval for the requested capacity.

A change in classroom has also been approved by Fountain Valley School District authority.

Facility meets all licensing requirements and file will be submitted for approval as of today.

Web address for downloading forms or regulations was provided as (http://ccld.ca.gov/PG411.htm).

Exit interview was conducted and a copy of this report was provided to the director on this date.

A copy of this report must be made available to the public for 3 years.

Notice of Site visit and appeal rights were presented to the Licensee.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2020

LIC809 (FAS) - (06/04)

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