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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371229
Report Date: 08/05/2020
Date Signed: 08/19/2020 01:43:00 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:HAVARD, TATUMFACILITY TYPE:
830
ADDRESS:3100 EAST BIRCH STREETTELEPHONE:
(714) 646-4285
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:10CENSUS: 5DATE:
08/05/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director : Tatum Havard TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ketki Desai conducted a virtual (Face time) Case Management Licensee initiated inspection for a change of capacity (Increase) in the infant classroom, at the above facility. Facility Director Ms. Havard, Tatum gave a virtual tour of the infant & toddler classrooms and play yard on the site.

On today's inspection the change of capacity (Increase) was done for Infant classroom.
The indoor activity space for infants is physically separate from other components, it is equipped with appropriate furniture and equipment including the cribs, changing table and feeding chairs. The furniture was in good repair in safe condition and was age appropriate for infants to access and move around safely.
Toys were safe and washed with a safe organic disinfectant made with distilled water/ white vinegar/tea tree oil and lavender oil.
Napping area was observed to have individual cribs, each crib had bedding with tight fitted sheets which are changed daily, there is a safe walkway in-between the cribs allowing staff to reach each infant without stepping or reaching over.
Infant changing table was observed to have padded surface covered with washable vinyl, with raided sides and sink was within arm’s reach.
Infant food area was clean, bottles, dishes and food containers brought from home were labeled with the infant’s name / date. Age appropriate seating equipment is used during feeding time.
Needs and Service plan is updated quarterly or as needed, there is ongoing communication with the parents via an electronic application daily.
Parents sign in electronically at the entrance of the facility.

Outdoor yard was observed to have safe age appropriate toys, the small play equipment’s are placed on a soft mat to absorb any falls. It was fenced and shaded.
There is waiver in place to share the outdoor area with the toddlers.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020
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: NORTH HILLS PRESCHOOL
FACILITY NUMBER: 304371229
VISIT DATE: 08/05/2020
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Measurements of the Indoor activity room is as follows:
Room Length Width Area Encumbered Total space
Infant 25.75 x 18.17 = 467.88 - 145.48 = 322.40 divided by 35 = 9.21
Toddlers 23.01 x 20.04 = 461.12 - 11.91 = 449.91 divided by 35= 12.85

Sinks: 2 x 15= 30
Toilets: 3 x 15= 45

Outdoor activity space

Infant / Toddler playground: 104.92 x 13.74= 1442.65 divided by 75= 19.24

Currently the facility is licensed for four infants and six toddler option children.

Based on today's measurements, facility has enough space for the requested capacity of 8 infants serving ages 6 weeks to 18 months in Infant room and 6 toddlers ages 18 months to 36 months in toddler room, Monday to Friday 7.00 am to 6.00 PM.

Fire clearance from Orange County Fire Authority has been received and approved for requested capacity on July 31st, 2020.

License shall be granted after the final approval by the management.

Report was read to the facility Director and read receipt shall be in lieu of signature.

Copy of the Report with Appeal rights were emailed along with posters of Safe Sleep / SIDS to the Facility Director via email.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2020
LIC809 (FAS) - (06/04)
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