304371230-7-12-2021-06-CC-KDEI-C4UQ8G-20210712115644

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371230
Report Date: 07/12/2021
Date Signed: 07/12/2021 11:56:59 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:	FUTABA PRESCHOOL		FACILITY NUMBER:	304371230
ADMINISTRATOR:	CHIZUKO, NAKAMURA		FACILITY TYPE:	850
ADDRESS:	23802 AVENIDA DE LA CARLOTA		TELEPHONE:	(949) 444-9403
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	45	CENSUS: 14	DATE:	07/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Ms.Yuki Ishida		TIME COMPLETED:	12:15 PM

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) Ketki Desai conducted an on-site pre licensing inspection at this proposed Day Care center. Licensee is requesting to add the new Toddler option to the current Preschool license on the same premises with addition of one classroom & storage room and a separate Toddler yard. LPA met with Facility Administrator Ms.Yuki Ishida and toured the new two classrooms, front toddler yard and the three designated preschool rooms. The applicant has requested to provide care and supervision for 18 Toddlers (18 months to 36 months) in room # 114 only. Room # 112 is designated as a Office / Storage room and children are not allowed in this room. Applicant is also adding a new Toddler yard. New rooms and yard were measured today. The facility operating hours are Monday to Friday from 8.00 am to 6.00 PM A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Office area is located in the hallway of the building. The corner of the office area Room #112 will serve as the isolation area for ill children temporarily until parents arrive. The staff bathroom will be used as the isolation bathroom and is conveniently located close to this area. This facility does not provide Incidental Medical Services (IMS) to children. Incidental Medical Service (IMS) policy was discussed. 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 when IMS is provided. 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 (Page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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: FUTABA PRESCHOOL	FACILITY NUMBER: 304371230
	VISIT DATE: 07/12/2021

NARRATIVE

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The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is provided by the parents in their personal water bottles, and they are refiled as needed.
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment shall be stored in individual cubbies when not in use
· The changing table is within arm’s reach of a sink with padded raised sides.
· Bedding will be taken home daily by the parents and extra beddings if needed is available.
Toddlers shall nap on cots which are stored outside the room
· The Toddler indoor area is physically separate from the preschool component

All food is provided by the parents, Facility has emergency snacks if needed to serve the children.

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610) / Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269)
· Sudden Infant Death Syndrome Poster
· Shaken Baby Syndrome Poste r

(Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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: FUTABA PRESCHOOL	FACILITY NUMBER: 304371230
	VISIT DATE: 07/12/2021

NARRATIVE

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The indoor activity space was measured and is as follows: Toddler room ( 114)

Room # 114 (Toddler room) : 23' 42 X 18'58 = 435'14
Total Indoor activity space: 435'14 divided by 35 = 12'43 (12 Toddlers)

Total children toilets and sinks: (1 sink and 1 toilet and 1 potty chairs shall be used) Sink : 1 x15= 15 infants

Preschool rooms: (measured earlier on 10/18/2018)
Room 106 : 29'25 X 19'25 = 563.06
Room 108: 29'25 X 19'25= 563'06
Room 110: 29'25 X 19'25 = 563'06

Total indoor preschool : 1689.18 divided by 35 = 48'26 ( 48 Preschool children)

LPA discussed with the applicant/facility representative that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant/facility representative was advised the infant crib area must be supervised at all times. No infant should be left unattended in the crib area. bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by bring out their personal water bottles
· Outdoor activity space is supplied with age and size appropriate equipment,
· An adequate amount of cushioning material consisting of green grass placed under the toys
· Adequate shade is provided by completed shaded awing and shaded patio
Toddler yard is accessed through hallway door into the fenced locked door. This yard is designated only for Toddler component. It is not shared with any other facilities on the premises. Preschool has their own yard.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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: FUTABA PRESCHOOL	FACILITY NUMBER: 304371230
	VISIT DATE: 07/12/2021

NARRATIVE

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Total outdoor activity space was measure and is as follows:
Toddler yard : 60 X 43'58 = 2,614.8

Total outdoor yard capacity: 2,614.80 divided by 75 = 34'86 ( 35 Toddlers)

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant/facility representative was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or 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 applicant/facility representative 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

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the applicant/facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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: FUTABA PRESCHOOL	FACILITY NUMBER: 304371230
	VISIT DATE: 07/12/2021

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Based on today’s measurements, this center does not have sufficient Indoor activity space to support the requested capacity for 18 Toddlers.

A license will be issued for the capacity of 12 Toddlers (18 months - 36 months) in Room # 114 only . Monday to Friday from 8.00 am to 6.00 PM , after a final review. Applicant shall be notified if additional information is needed.
Preschool is licensed for 45 children ages ( 2-5 years of age) in Room # 106,108 and 110 and Room # 112 is used as a office/Storage room.

Approval from Orange county Fire Authority has been received for the requested capacity.

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, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

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