304371518-8-6-2021-06-CC-STOE-C5MV5S-20210806160825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371518
Report Date: 08/06/2021
Date Signed: 08/06/2021 04:08:35 PM

Document Has Been Signed on 08/06/2021 04:08 PM - It Cannot Be Edited

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:	AESD ROOSEVELT PRESCHOOL		FACILITY NUMBER:	304371518
ADMINISTRATOR:	VILLEGAS, M. & JELINEK, V.		FACILITY TYPE:	850
ADDRESS:	1600 EAST VERMONT		TELEPHONE:	(714) 517-7125
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92805
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/06/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:	Viviana Jelinek, School Readiness Coordinator		TIME COMPLETED:	11:00 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) Stacy Torrence conducted an onsite prelicensing inspection at this proposed childcare center. LPA met with Viviana Jelinek, School Readiness Coordinator and toured the center. The facility representative has requested to provide care and supervision for 24 preschool children; ages 2.9 to 5 years of age; Monday through Friday, AM session: 8:00 - 11:00 and PM session: 12:30-3:30. In classroom: #28. The facility is located on the AESD Roosevelt Elementary School campus. 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. Isolation area for ill children is located in the student care room which is the nurse’s office in the school front office There is also a is restroom for ill children and is conveniently located to the isolation area. Medication will be stored in the classroom, in a locked cabinet located above the sink. Medication administration forms were reviewed. First Aid supplies were inspected and are stored in each classroom. EMSA approved Pediatric CPR & First Aid are current for the site supervisor and expires on 02/2023. Facility representative completed the 8-hour Preventative Health Practices and Nutrition Course and Lead Preventative Training completed. 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. Continue on next page (1 of 5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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: AESD ROOSEVELT PRESCHOOL	FACILITY NUMBER: 304371518
	VISIT DATE: 08/06/2021

NARRATIVE

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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 children being their own water bottle from home and drinking fountain
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

Center provide breakfast for the AM children and lunch for the PM children, which is delivered to the facility by the school district cafeteria.

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)
Sudden Infant Death Syndrome Poster (recommended)
Shaken Baby Syndrome Poste r (recommended)

The indoor activity space was measured and is as follows:
Room: #28: 46.07 x 24.09= 1,147 sqft
Total: 1,147 sqft divided by 35= 32 children

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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: AESD ROOSEVELT PRESCHOOL	FACILITY NUMBER: 304371518
	VISIT DATE: 08/06/2021

NARRATIVE

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Total children toilets and sinks:
Toilets: 1 x 15 = 15 children
Sinks: 2 x 15 = 30 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 children bringing their own water bottle from home labeled with their names.
Outdoor activity space is supplied with age and size appropriate equipment, including swings, slides, and climbing equipment.
An adequate amount of cushioning material consisting of foam is in place under the play equipment.
Adequate shade is provided by shade sails and structures
No bodies of waters on the premises

Total outdoor activity space was measure and is as follows:
Preschool Playground: 217.4 x 71 = 15,435 sqft.
Total: 15,435 sqft. divided by 75 = 205 children

The facility has requested an inclusion waiver for Early Childhood Education and Early Childhood Special Education for shared outdoor activity space, located on the early education playground

The facility representative 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

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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: AESD ROOSEVELT PRESCHOOL	FACILITY NUMBER: 304371518
	VISIT DATE: 08/06/2021

NARRATIVE

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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 facility representative was also informed to visit the website for Quarterly Updates. The facility representative 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 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

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian.

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 indoor and outdoor activity space to support the capacity of 24. However, the limited factor is the availability of toilets, the center does not have a sufficient number of toilets to support the capacity of 24.

Fire Clearance granted on 08/04/2021.

Prior to licensing the following documents must be submitted to the licensing office by due date of 08/13/2021:

1. Waiver request for shared bathrooms with the ECSE. located on the early education playground
2. Waiver request for reverse mainstream for indoor and outdoor activity.

The facility representative will be notified if any additional information is required. After final review a license will be issued.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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: AESD ROOSEVELT PRESCHOOL	FACILITY NUMBER: 304371518
	VISIT DATE: 08/06/2021

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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 facility representative 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.

End of Report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

LIC809 (FAS) - (06/04)

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