304371435-5-28-2020-06-CC-KDEI-BQ2PL3-20200528112403

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371435
Report Date: 05/28/2020
Date Signed: 05/28/2020 11:24:21 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:	TUSD KINDERGARDEN READINESS-MYFORD		FACILITY NUMBER:	304371435
ADMINISTRATOR:	CABIBI, LAURALEE		FACILITY TYPE:	850
ADDRESS:	3181 TREVINO DRIVE		TELEPHONE:	(714) 730-7592
CITY:	IRVINE	STATE: CA	ZIP CODE:	92602
CAPACITY:	24	CENSUS: 0	DATE:	05/28/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Cabibi Lauralee		TIME COMPLETED:	11:45 AM

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’s) Ketki Desai conducted an on-site pre-licensing inspection at this proposed child care center. LPA met with Administrator Cabibi Lauralee and toured the site. The applicant has requested to provide care and supervision for Pre-school age children 3 to 5 years of age, Monday through Friday, 7.00 am. to 4.30 pm. in one classroom (201) assigned on Myford Elementary school site. The school is under the Tustin Unified School district and school calendar shall be followed through the year. Currently the campus is closed. 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. The children shall have access through the side entrance of the school campus, where parents will drop off and pick up the children during opening and closing hours of the day. Parents shall sign in at the entrance gate upon arrival. Once the school opens the door is locked and later the parents would have to come in through the school reception office area. 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 Incidental Medication will be stored in the classroom in a locked cabinet and shall be administered by the teacher. Medication administration forms were reviewed. Isolation area is the Nurse’s office on the school complex.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020

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: TUSD KINDERGARDEN READINESS-MYFORD	FACILITY NUMBER: 304371435
	VISIT DATE: 05/28/2020

NARRATIVE

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The following were inspected in the indoor activity space:
· Classroom is adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through water fountain as well as individual sports bottles
· 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 teacher’s closet area when not in use and cots shall be used.

Facility policy is that lunches are provided by the parents, and AM/PM snack are provided by the school Nutrition center, which are delivered in a pre-packed containers.

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)

The indoor activity space was measured and is as follows:
Room # 201: 25.83 X 30.35 = 781.36 ( larger area)
39X 6.42 =250.38
Total: 1031.74 divided by 35 = 29.48

One sink = 15 children / One Toilet and one Urinal =15 / Fire clearance approved the requested capacity.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020

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: TUSD KINDERGARDEN READINESS-MYFORD	FACILITY NUMBER: 304371435
	VISIT DATE: 05/28/2020

NARRATIVE

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Classroom has one sink , toilet and urinal but there are additional toilets / sinks /urinals for Girls and Boys in the hallway, which shall be accessible to children. There is Waiver in place to share the restroom with the Kinder garden children on school premises.

As per the Administrator all the staff employed shall be live scanned through the School district, but shall continue to meet 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 children's 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 fountain, individual sports bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor scooters. Additional items to be stored in a locked shed.
· An adequate amount of cushioning material consisting of rubber form is in place under the play structures
· Adequate shade is provided by canvas canopy on top of play structures)

Waiver in place; Shared play yard with Kinder garden children on the school district premises.

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

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

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020

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: TUSD KINDERGARDEN READINESS-MYFORD	FACILITY NUMBER: 304371435
	VISIT DATE: 05/28/2020

NARRATIVE

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The facility was in compliance with Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has sufficient activity space to support the capacity of 24 ( Preschool children). A license will be issued for the capacity requested after a final review. The applicant will be notified if any additional information is required.

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: 05/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020

LIC809 (FAS) - (06/04)

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