304371488-4-12-2021-06-CC-STOE-C223TA-20210412183136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371488
Report Date: 04/12/2021
Date Signed: 04/12/2021 06:31:53 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:	GREAT FOUNDATIONS MONTESSORI-WOODBURY		FACILITY NUMBER:	304371488
ADMINISTRATOR:	BLANK		FACILITY TYPE:	830
ADDRESS:	6304 IRVINE BLVD.		TELEPHONE:	(714) 389-2400
CITY:	IRVINE	STATE: CA	ZIP CODE:	92620
CAPACITY:	24	CENSUS: 16	DATE:	04/12/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:21 PM
MET WITH:	Jessy Wang, Director		TIME COMPLETED:	03:22 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 Analysts (LPAs) Stacy Torrence and Lou VanZant conducted an announced, on site pre-licensing inspection for the purpose of change in ownership. LPAs met with Jessy Wang, Director and Shirley Scholfield previous owner, who guided LPAs on a tour of the facility. There were 16 infants present and six staff supervising during today’s inspection. Applicant has requested a license to care for eight infants; ages 0-24 months; from 6:30 a.m. to 6:30 p.m., Monday through Friday, in classrooms: #1 and #2. 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. During the inspection, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Check-in procedure is as follow: parents sign in/out children utilizing a biometric system, in which, parents place their thumb on the device, children’s temperature is taken, the receipt is printed out and given to the director, director walk children to their classroom, children then wash their hands. Office area is located in the front corner of the building and 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 to the isolation area. Medication will be stored in a locked box in either the front desk or in the kitchen if refrigeration is required. First Aid kit is complete and located in the file cabinets in the individual classrooms. An emergency backpack is stored in the storage room. EMSA approved Pediatric CPR & First Aid are current for the director and expires on 09/2022. Applicant/facility representative completed the 8-hour Preventative Health Practices and Nutrition Course with A-B-CPR and First Aid Training, dated 11/2019. Lead Poisoning Training has not been completed

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: GREAT FOUNDATIONS MONTESSORI-WOODBURY	FACILITY NUMBER: 304371488
	VISIT DATE: 04/12/2021

NARRATIVE

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Parent provides infant formula, which is kept in the refrigerator, with name and date. Food preparation area is equipped with, refrigerator/freezer. Center policy is that lunches are prepared by Woodbury facility and brought to location. Facility provides AM/PM snacks. Evaluator reviewed Title 22 Sections 101227 and 101327 with applicant and that the licensee is ultimately responsible to provide adequate, nourishing food.

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
· 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 statutory requirements
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· The changing table is within arm’s reach of a sink
· The changing table is padded with raised sides
· Bedding will be washed daily on site by the facility
· There is a designated napping area surrounded by a 4 ft wall with sufficient infant napping equipment
· The infant indoor is physically separate from the preschool/toddler component

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
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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: GREAT FOUNDATIONS MONTESSORI-WOODBURY	FACILITY NUMBER: 304371488
	VISIT DATE: 04/12/2021

NARRATIVE

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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 (recommended)
· Shaken Baby Syndrome Poste r (recommended)

Classrooms are adequately equipped with age and size appropriate furniture and equipment. A waiver has been requested to allow children 12 months and older to nap on a cot/mat.

Total indoor activity area:
Room #1: 465 sqft
Room #2: 465 sqft
Total 930 sqft divided by 35 = 26 children

Total children toilets and sinks:
Toilets: 1 X 15 = 15 children
Potty Chairs: 2 X 5 = 10 children
Sinks: 3 X 15 = 45 children

LPA discussed with the 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. 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
· Outdoor activity space is supplied with age and size appropriate equipment, including small climbing and small slide

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: GREAT FOUNDATIONS MONTESSORI-WOODBURY	FACILITY NUMBER: 304371488
	VISIT DATE: 04/12/2021

NARRATIVE

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· An adequate amount of cushioning material consisting of rubber foam is in place under the play structures
· Adequate shade is provided by awning

Total outdoor activity area:
1,800 sqft divided by 75 = 24 children

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

Facility representative was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to download 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

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

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: GREAT FOUNDATIONS MONTESSORI-WOODBURY	FACILITY NUMBER: 304371488
	VISIT DATE: 04/12/2021

NARRATIVE

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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 and not be too hot or too cold
Based on today’s measurements, and the sink and toilet availability, this center has sufficient activity space to support the capacity of 24 infants. A license will be issued for the capacity of 24 infants after a final review. The applicant will be notified if any additional information is required.

Prior to licensing the document must be submitted to the licensing office by the due date of: 04/16/2021
1. Waiver requesting children 12 months and older to nap on a cot/mat.

Facility is in the process of completing the testing of their water.

Facility representative 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: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

LIC809 (FAS) - (06/04)

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