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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371270
Report Date: 05/29/2019
Date Signed: 06/13/2019 03:44:26 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:EV FREE PRESCHOOLFACILITY NUMBER:
304371270
ADMINISTRATOR:ERNST, STEFANIFACILITY TYPE:
840
ADDRESS:2801 BREA BLVD.TELEPHONE:
(714) 257-4302
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:28CENSUS: 0DATE:
05/29/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Stefani Ernst, DirectorTIME COMPLETED:
11:15 AM
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An inspection was conducted on this date by Licensing Program Analyst (LPA) Torrence for the purpose of licensure of a school-age child care center. LPA met with Director Stefani Ernst. There were no school-age children present during today's inspection. Applicant is seeking to provide care for 28 school-age children; ages 5 years old to 12 years old. The proposed program will operate during summers when elementary schools are closed. Operation hours are from 8:00 am to 5:00 pm Monday – Friday.

The director’s office is located in the back of the facility’s front office. There is a room next to the Director’s office which 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. First Aid kit is complete. Sign in / Sign out procedure was reviewed. This facility utilizes an electronic sign in/out system. Each authorized representative will utilize their own unique four-digit PIN, which will serve as the authorized representative signature. Once the code is entered, the system will generate the name of the authorize representative and the sign in/sign out time and date. As a backup plan, the facility has a manual sign in/out book.
The following approximate measurements were taken for the requested indoor activity space: Classrooms 204B and 205B have been designed for this school-aged program.
Indoor Activity Space:

Room 204B: 35.04 sqft. x 23.06 sqft. =808.02 sqft. - 30.19 sqft. (encumbered)= 777.83 sqft.
Room 205B: 35.06 sqft. x 23.07 sqft. =808.83 sqft. - 30.19 sqft. (encumbered)= 778.64 sqft.

Total 1556.48 sqft. divided by 35 = 44.47 children
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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 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: EV FREE PRESCHOOL
FACILITY NUMBER: 304371270
VISIT DATE: 05/29/2019
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Page 2-809-C

Bathrooms: children's bathrooms consist of:
Total children toilets and sinks:
Toilets: 14 x 15 = 210 children
Sinks: 17 x 15 = 255 children

The total indoor activity space is 1556.48 square feet divided by 35 which accommodate approximately 44 school-age children.
Outdoor Activity Space:
School-Aged Playground: 52.42 x 51.42 = 2695.44 sqft. divided by 75 = 35 children.
Applicant has requested a waiver to share the playground area with the school-age and preschool children on a rotating schedule. Applicant also has requested to use the gym for gross motor activities.

The Fire Department has granted a fire clearance for 28 school-aged children. Fire Clearance is dated 04/25/2019.



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/front office will serve as the isolation area for ill children until parents arrive.
-Children bring their water bottles from home; if more water is needed, a water pitcher is located in each classroom. There are water faucets located outdoor.
-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 canopies
-Parents provide food for their children.
-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. Each authorized representative will utilize their own unique four-digit PIN code, which will serve as the authorized representative signature.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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: EV FREE PRESCHOOL
FACILITY NUMBER: 304371270
VISIT DATE: 05/29/2019
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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. Facility was advised that a certificate of completion for Mandated Reporter training for staff members shall be kept on file. Facility was provided with a hard copy of the California Department of Social Services Lead Information Brochure.
This facility is currently receiving quarterly updates.

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 28 children.

Prior to licensure the following is required:

· Waiver Request to Share Outdoor Playground
· A fire clearance of the inspection of the gym

Exit interview was conducted with Director, Stefani Ernst. 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.

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

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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: EV FREE PRESCHOOL
FACILITY NUMBER: 304371270
VISIT DATE: 05/29/2019
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Facility was provided with a hard copy of the California Department of Social Services Lead Information Brochure. This facility is currently receiving quarterly updates.

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 28 children.

The facility was in compliance with the California Code of Regulations, Title 22, Division 12, during today's inspection; however, prior to licensure there will be a final review of the facility’s file.

Exit interview was conducted with Director, Stefani Ernst. 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.

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

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4