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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371221
Report Date: 07/15/2021
Date Signed: 07/15/2021 11:42:55 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/HARVEY ELEMENTARYFACILITY NUMBER:
304371221
ADMINISTRATOR:TRAN, NGOCFACILITY TYPE:
850
ADDRESS:1635 S. CENTER STREETTELEPHONE:
(714) 431-7542
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:21CENSUS: 5DATE:
07/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Adminstrator- Tran, NgocTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Corral conducted an onsite inspection for the purpose of an Annual Inspection. LPA Corral and Administrator Tran, Ngoc toured the inside and outside of the classroom. There were 5 children present in care with 2 staff members providing care and supervision. Due to COVID 19 Guidelines, LPA Corral observed staff members and children wearing face masks, social distancing and following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are Monday – Friday, 8 a.m.- 4 p.m. A review of the Facility Personnel Report Summary conducted on 07/13/2021 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 above 5 feet high and locked away. Poisons/Hazardous items are not kept on the premises. SAUSD provides and prepares breakfast, lunch, and PM Snack. Menus were posted and visible for parents to review and shared with the parents using the Class Dojo application. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. Drinking water is available for children indoors by the use of their own water bottles. The children's bathroom is located down the hallway to the right, the bathroom was observed to be clean and sanitary. Children nap on cots, bedding is provided by the SAUSD, the sheets are stored individually and are taken home weekly to be washed by parents. The facility conducted a Fire Drill on 07/12/2021 and a Disaster Drill on 06/25/2021. 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 the staff present during the facility inspection, 3 staff files were reviewed.
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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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/HARVEY ELEMENTARY
FACILITY NUMBER: 304371221
VISIT DATE: 07/15/2021
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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 family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles and influenza for Administrator and 2 Staff members 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. Administrator and both teachers were in compliance with mandated reporting training, Tran, Ngoc completed her Mandated Reporter 06/19/2021. At least one staff member present possesses a current Pediatric CPR/First Aid certification, Administrator’s CPR/First Aid expires on 09/2022. LPA Corral also reviewed Children's Records. Each child’s record contained information of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or someone who can assume responsibility for the child if the authorized representative cannot be reached. Each child’s record contained a medical assessment form which was the SAUSD Health Record Assessment and Health Screening or the SAUSD Physical Exam Form.

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

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence of at least five feet high. The surface of the outdoor activity space was well maintained and free of hazards. The soft foam cushioned material around the play equipment appeared to be enough to absorb a fall. Drinking water in the outdoor activity space is provided by the use of the child’s own water bottle. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Administrator Tran, Ngoc was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov, she was also informed she 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.
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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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/HARVEY ELEMENTARY
FACILITY NUMBER: 304371221
VISIT DATE: 07/15/2021
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LPA Corral provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian Information on nutrition training, immunization requirements for children, and Health Schools Acthttp://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. Administrator was informed about the California Child Care Disaster Plan website: cchp.ucsf.edu/content/disaster-preparedness LPA Corral also provided information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure will be provided via email.

LPA Corral provided a copy of the PIN 20-06-CCP Social and Physical Distancing Guidance. Administrator was provided with a Copy of the 2016 “A Child Care Providers Guide to Safe Sleepttps://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
Administrator was informed of the following:
· Always place infants on their backs for sleeping, use a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib, keep all items, including blankets out of the crib
· 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

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.

LPA Corral conducted an Exit Interview, the report was read reviewed and discussed with Administrator Tran, Ngoc. Appeal Rights were explained. Administrator was provided a copy of Appeal Rights (LIC 9058) and signature on this form acknowledges receipt of these rights. Administrator was informed all appeals must be in writing and received by the Regional Office within 15 business days. Notice of Site Visit was provided and posted by Administrator. Ngoc was informed the Notice of Site Visit must be posted for 30 consecutive days and failure to post will result in a Civil Penalty of $100.00.
End of Report.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen CorralTELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
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