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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371229
Report Date: 05/01/2019
Date Signed: 05/01/2019 01:23:12 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:NORTH HILLS PRESCHOOLFACILITY NUMBER:
304371229
ADMINISTRATOR:UNKNOWNFACILITY TYPE:
830
ADDRESS:3100 EAST BIRCH STREETTELEPHONE:
(714) 457-2504
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:10CENSUS: 0DATE:
05/01/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Tatum HavardTIME COMPLETED:
01:30 PM
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An inspection was conducted on this date by Licensing Program Analyst (LPA) Torrence for the purpose of licensure of a child care center. LPA met with Director, Tatum Havard. There were no infants or toddlers present during today's inspection. Applicant is seeking to provide care for four infants (ages 6 weeks old) and six toddler option children (ages 18 months-36 months). The proposed program will operate from 7:00 am to 6:00 pm Monday – Friday.

There are two entrances to this facility. The director’s office is located down the hallway from the first entrance and will serve as the isolation area for ill infant and toddler children temporarily until parents arrive. The staff bathroom will be used as the isolation bathroom and is located down the hallway from the second entrance. The Director stated that she will also have a potty chair and a cot in the office for the ill children. First Aid kit is complete. Sign in / Sign out procedure was reviewed. This facility utilizes an electronic sign in/out system. There will be a tablet in each classroom, in which, the authorized representative will enter their unique four-digit code. Once the code is entered, the authorized representative will slide to the next screen, in which, a signature screen will appear, to allow the representative to sign in/out their child. As a backup plan, the facility has a manual sign in/out book.

LPA toured the entire facility indoors and outdoors. The following approximate measurements were taken for the indoor activity space: Infant room and Toddler Option. The total indoor activity space for the infant room is approximately 322 square feet divided by 35 which accommodate approximately nine infants. There were four cribs located in the infant napping area; surrounded by a Plexiglass wall; separating this area from the activity area. The changing table is adjacent to the sink. The total indoor activity space for the toddler option room is approximately 449 square feet divided by 35 which accommodate approximately 12 toddlers. There were three toilets and two sinks in the toddler option room.

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: NORTH HILLS PRESCHOOL
FACILITY NUMBER: 304371229
VISIT DATE: 05/01/2019
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Facility was advised that a certificate of completion for Mandated Reporter training for staff members shall be kept on file. A hard copy of Form 311A, Records to be Maintained at the Facility – Child Care Centers was provided to the facility representative. Facility was provided with a hard copy of the California Department of Social Services Lead Information Brochure. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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


Based on today’s measurement and the sink and toilet availability, the center has sufficient activity space to support the capacity of 10 children.

Prior to licensure the following is required:

· Waiver Request to Share Outdoor Playground
· Director needs to complete 8-hour Preventative Health Practice. Director has already signed up for the class which is schedule for 05/19/19. LPA advised Director to submit a copy of the certificate of completion by due date of 05/20/19.
· Director is currently enrolled in an infant class and is scheduled to receive her Bachelor of Arts degree this month. Upon receiving her degree, Director need to submit a copy of such degree.

Exit interview was conducted with Director, Tatum Havard. Report reviewed and discussed. Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed. The director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Director was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

END OF REPORT

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: NORTH HILLS PRESCHOOL
FACILITY NUMBER: 304371229
VISIT DATE: 05/01/2019
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The following approximate measurements were taken for the infant/toddler option outdoor activity space. The total outdoor activity space is 1442 square feet divided by 75 which accommodate approximately 19 children. There is an appropriate fence and space that separates the preschool playground from the infant/toddler option playground. Shade is provided by umbrellas. Licensee has requested a waiver to share the playground area with the infant and toddler children on a rotating schedule.

The Fire Department has granted a fire clearance for four infants and six toddler option children. Fire Clearance is dated 04/15/2019.

The following was observed:
-There is a working smoke detector and fire extinguisher that meet statutory requirements
-Classrooms are adequately equipped with age and size appropriate furniture and equipment
-The director’s office will serve as the isolation area for ill children until parents arrive.
-Water is available by children indoor by bringing their own water bottles from home (with the child’s name on it) and outdoor water is available by a water pitcher and disposable cups.
-Playground is fully enclosed by an appropriate fence.
-Outdoor activity area is supplied with age and size appropriate equipment.
-There is adequate shade provided outdoor by trees and umbrellas.
-AM and a PM snack is are provided by the facility.
-A separate staff bathroom is available for adults.
-Medication will be stored in the Director’s office locked in a cabinet inaccessible to children.
-First Aid kit is complete.
-Sign in/Sign out procedure was reviewed and meets regulation requirements. This facility utilizes an electronic sign in/out system. There will be a tablet in each classroom, in which, the authorized representative will enter their unique four-digit code, which allow the representative to sign in/out their child.

Applicant was notified about emergency/disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, mandated reporter training, staff and other individual immunization/proof of immunity requirements against measles, pertussis and influenza, and fingerprint clearance requirements.

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3