304371183-12-13-2019-06-CC-JMHN-BJU34T-20191213165537

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371183
Report Date: 12/13/2019
Date Signed: 12/13/2019 04:55:54 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:	SAUSD/SANTIAGO ELEMENTARY		FACILITY NUMBER:	304371183
ADMINISTRATOR:	IBRAHIM, FADWA		FACILITY TYPE:	850
ADDRESS:	2212 N. BAKER STREET		TELEPHONE:	(714) 431-7542
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92706
CAPACITY:	24	CENSUS: 19	DATE:	12/13/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Veronica Berber Aceves - Site supervisor & Fadwa Ibrahim - Lead Teacher		TIME COMPLETED:	10:20 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	Licensing Program Analyst (LPA), Jungmi Han conducted an onsite inspection for the purpose of an Annual Random. LPA toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in K-2 classroom. The overall census observed was 3 preschool staff and 22 preschool children. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children such as 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. Food is prepared on site; breakfast, lunch, and snack are provided. Food prep areas were clean and sanitary. Food is properly stored. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by drinking fountain and cup and pitcher. The children's bathrooms are clean and sanitary. Children nap on cots and bedding is stored individually and is taken home weekly to be washed by parents. The facility has conducted an emergency drill within the past six months. 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 Staff files were reviewed for staff present during the facility inspection this date. 3 out of 3 staff files were reviewed. Health screening and immunizations as required were reviewed. Page 1 of 4

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

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: SAUSD/SANTIAGO ELEMENTARY	FACILITY NUMBER: 304371183
	VISIT DATE: 12/13/2019

NARRATIVE

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Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a child care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff 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. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 7/2021. LPA reviewed staff#1’s transcripts and signed off evaluation of teacher qualification (LIC9095).

The site supervisor 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. Site supervisor was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182).

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 9 of children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day. LPA received current children’s roster and fire disaster drill log during the inspection.

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

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/SANTIAGO ELEMENTARY	FACILITY NUMBER: 304371183
	VISIT DATE: 12/13/2019

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
cushioning material rubber mats commercially produced for the purpose around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by drinking fountain. LPA observed the outdoor water table cover has sharp edges. Site supervisor removed water table cover during the inspection. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Inspection and report reviewed and exit interview was conducted in English. The site supervisor was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Site supervisor and staff may request to be added to an email list to receive a Quarterly Update at www.ccld.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 site supervisor 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.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the site supervisor.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib

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SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/SANTIAGO ELEMENTARY	FACILITY NUMBER: 304371183
	VISIT DATE: 12/13/2019

NARRATIVE

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· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

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 exit interview was completed with site supervisor. The report was reviewed and discussed. Appeal Rights and deficiencies were 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.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019

LIC809 (FAS) - (06/04)

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