304371455-9-3-2020-06-CC-DVAA-BT4ULE-20200903154033

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371455
Report Date: 09/03/2020
Date Signed: 09/03/2020 03:41:23 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:	SUSAN PHILLIPS DAY SCHOOL		FACILITY NUMBER:	304371455
ADMINISTRATOR:	HERRON, MARTY		FACILITY TYPE:	850
ADDRESS:	381 UNIVERSITY DRIVE		TELEPHONE:	(949) 645-1949
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	15	CENSUS: 0	DATE:	09/03/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Steve and Marty		TIME COMPLETED:	04:00 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)Dean Valencia conducted an on site prelicensing visit at this proposed child care center. LPA met with the applicant/administrator and the director and toured center. The applicant/facility representative has requested to provide care and supervision for children 4 through 6 years of age, Monday through Thursday 8:30 a.m. to 2:30p.m. in room A, located in suite A of 381 University Dr. 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 will serve as the isolation area for ill children temporarily until parents arrive. The staff/adult restroom will be used as the isolation restroom for ill children and is conveniently located to the isolation area. Medication will be stored in the office. Medication administration forms were reviewed. First Aid supplies were inspected and are stored on site. EMSA approved Pediatric CPR & First Aid are current and has completed the 8-hour Preventative Health Practices and Nutrition Course. 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 The following were inspected in the indoor activity space: · Classroom are adequately equipped with age and size appropriate furniture and equipment · Drinking water is available inside by cups and pitcher water cooler, individual sports bottles · Sign in/Sign out procedure was reviewed and meets regulation requirements · There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet requirements · Cubbies available for storage of individual child’s personal belongings (continued on LIC809C)

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020

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: SUSAN PHILLIPS DAY SCHOOL	FACILITY NUMBER: 304371455
	VISIT DATE: 09/03/2020

NARRATIVE

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Food preparation area is equipped with microwave oven, refrigerator/freezer. Center policy is that lunches are provided by the parents, and AM/PM snack are provided by the center. Evaluator reviewed Title 22 Sections 101227 and 101327 with applicant and that the licensee is ultimately responsible to provide adequate, nourishing food.

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 (when applicable)
· Plan of Corrections of Type A deficiencies (when applicable)
· Granted Waivers (available for review/when applicable)
· Child Car Seat Law (PUB 269)
· Sudden Infant Death Syndrome Poster (recommended)
· Shaken Baby Syndrome Poste r (recommended)

The indoor activity space was measured and is as follows:
Room A 749 sq ft
Total 749 sq ft divided by 35 = 21 children

Total children toilets and sinks:
Toilets: 1 X 15 = 15 children
Sinks: 2 X 15 = 30 children

(continued on LIC809C, page 3)

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020

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: SUSAN PHILLIPS DAY SCHOOL	FACILITY NUMBER: 304371455
	VISIT DATE: 09/03/2020

NARRATIVE

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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 children's bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the indoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by cups and pitcher water cooler and individual sports bottles
· Outdoor activity space is supplied with age and size appropriate equipment
· An adequate amount of cushioning material consisting of sand.
· Adequate shade is provided by an awning and shade.

Total outdoor activity space was measure and is as follows:
Total: 9225 sq ft divided by 75 = 123 children

OCFA has approved the capacity of 15 and a signed Inspection report STD850 has been received in the office on 9/3/20.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Director has to complete Lead Testing Training and Provisional License will only be granted until this training is completed. 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/facility representative 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 trainings 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
(continued on LIC809C, page 4)

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020

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: SUSAN PHILLIPS DAY SCHOOL	FACILITY NUMBER: 304371455
	VISIT DATE: 09/03/2020

NARRATIVE

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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
https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt
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 15. Limiting factor for capacity is 21. A license will be issued for the capacity of 15 due to limited toilet(s), after a final review. Prior to licensing the following must be submitted to the licensing office by the due date of 9/10/20: Fire Inspection Report (STD850) and Lead Testing Cert.
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.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020

LIC809 (FAS) - (06/04)

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