304371455-5-21-2021-06-CC-KDEI-C38PE2-20210521111425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371455
Report Date: 05/21/2021
Date Signed: 05/21/2021 11:14:40 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:	SUSAN PHILLIPS DAY SCHOOL		FACILITY NUMBER:	304371455
ADMINISTRATOR:	HERRON, MARTY		FACILITY TYPE:	850
ADDRESS:	381 UNIVERSITY DRIVE, STE. A		TELEPHONE:	(949) 645-1949
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	15	CENSUS: 0	DATE:	05/21/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator Ms. Herron Marty & Mr. Schaefar, Steve		TIME COMPLETED:	11:30 AM

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Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Case Management Licensee initiated inspection for a change in capacity by adding an additional toilet and one sink in the classroom A at Susan Philips Day School -Suite A.

Licensee is requesting a change to the current Preschool capacity from 15 preschool age children to 21 preschool children ages (4-6) years old. Monday to Friday (8.30 am to 2.30 PM)

LPA met with Facility Administrator Ms. Herron Marty and Mr. Schaefar, Steve the Director of Operations/ Treasurer who gave a tour of the Preschool classroom A at the above site.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, were inspected. Availability of drinking water was reviewed.

Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure.
An adequate amount of cushioning material (sand) are in place under the equipment. Shade is provided by awnings and a Water pitcher and personnel water bottles are used for drinking water. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, and criminal records clearances/exemption transfer requests.

The children in this program have designated Rest time after the Outdoor activities.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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: SUSAN PHILLIPS DAY SCHOOL	FACILITY NUMBER: 304371455
	VISIT DATE: 05/21/2021

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All the two Preschool room was measured on today’s inspection and the measurements are as follows:

Classroom A	12.58	8.33	104.79
	33.58	21.08	707.86

Total Indoor capacity: 812’65 divided by 35 = 23.22 (23 children)

Outdoor Activity Space: Total: 9225 sq. ft divided by 75 = 123 children (measured during Pre-Licensing on 9/3/20)

An Outdoor Waiver was approved to share outdoor activity space with Int’l Christian Montessori Academy and ICMA (2) on a rotating basis.

Total Sinks: 3 x 15 = 45
Total Toilets: 2 X15= 30 (2 toilets and 3 sinks are in the classroom)

Based on today’s inspection and Indoor and Outdoor measurements, Facility has enough space to accommodate 21 Preschoolers (4-6 years old) Monday to Friday 8.30 am to 2.30 PM, in the one designated Classroom A on the premises of International Christian Montessori Academy.

Orange county fire Authority have completed the Fire inspection and approved the requested capacity.

Administrator Ms. Herron, Marty is current on the required CPR training (7/22).

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

Report was read to the Facility Administrator and appeal rights were provided and Notice of Site visit was posted.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC809 (FAS) - (06/04)

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