304371535-10-6-2021-06-CC-STOE-C7JQHX-20211006121153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371535
Report Date: 10/06/2021
Date Signed: 10/06/2021 12:12:18 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:	TRABUCO PRESBYTERIAN CHURCH PRESCHOOL		FACILITY NUMBER:	304371535
ADMINISTRATOR:	VANDERHOFF,KATHLEEN		FACILITY TYPE:	850
ADDRESS:	31802 LAS AMIGAS		TELEPHONE:	(949) 713-6989
CITY:	TRABUCO CANYON	STATE: CA	ZIP CODE:	92679
CAPACITY:	60	CENSUS: 0	DATE:	10/06/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Chris Yrajui, Licensee & Kathleen Vanderhoff		TIME COMPLETED:	12:15 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) Stacy Torrence conducted an onsite prelicensing visit at this proposed childcare center. LPA met with Chris Yragui, Licensee and Kathleen Vanderhoff, Director toured center. The applicant has requested to provide care and supervision for children 2 to 6 years of age, Monday through Friday, 7:30 a.m. to 5:30 p.m. in classrooms: #1, #2, and #3. 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 director’s office located by the reception 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 director’s office, in a locked and key box, located in a locked cabinet and in the refrigerator, if needed. Medication administration forms were reviewed. First Aid supplies were inspected and is stored in every classroom and one is located on the playground. EMSA approved Pediatric CPR & First Aid are current for the director and expires on 08/2022. Director completed the 8-hour Preventative Health Practices and Nutrition Course with Heart Plus, including Lead Training on 06/2021. Licensee completed the 8-hour Preventative Health Practice and Nutrition Course, including Lead Training with The Training Source (EMSA approved) on 04/2021. 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)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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: TRABUCO PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 304371535
	VISIT DATE: 10/06/2021

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 bringing their own water bottles from home labeled with their names and the facility will provide refills
· 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 and will be taken home weekly to be washed.
· Napping equipment shall be stored in the hallway

Center policy is that parents will provide AM snack, lunch, and PM snack. Center will have extra snacks for the children, if needed. Evaluator reviewed Title 22 Sections 101227 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
· 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)

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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: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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: TRABUCO PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 304371535
	VISIT DATE: 10/06/2021

NARRATIVE

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Updated face covering guidance was provided and director was to continue to message the “Three W’s”: Wash your hands. Watch your physical distance. Wear a mask. This face covering guidance is for all individuals 2 years and older, except for the exceptions (child’s development, medical exemptions, etc.) that are outlined by CDPH.
Important COVID-19 resources and links were provided:
· CDC Student become sick diagnosis flowchart

· CDC Example of Routine Childcare disinfecting

· CDC Stop the Spread of Germs poster
· COVID-19 General Guidance Cleaning/Disinfecting in Childcare facilities:
· COVID-19 Update Guidance Childcare Programs/Providers link:

https://files.covid19.ca.gov/pdf/guidance-childcare.pdf

· CCLD COVID-19 Licensed childcare and facilities and provider FAQs link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources/faqs-for-licensed-child-care-facilities-and-providers

Safe, free, and effective COVID-19 vaccines are now available to everyone age 16 and up. Every Californian can sign up at myturn.ca.gov or call (833) 422-4255 to get their COVID-19 vaccine appointment.

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 activity space to support the capacity of 55. Limiting factor for capacity is inside and outside activity space.

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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: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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: TRABUCO PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 304371535
	VISIT DATE: 10/06/2021

NARRATIVE

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The indoor activity space was measured and is as follows:
Room #101: 29.06 x 19.01 = 552 sqft
Room #102: 34.11 x 16.05 = 547 sqft
Room #103: 34.02 x 25.05 = 852- 6(incumbered space 2.1 x 2.7) 846 sqft
Total 1,945 sqft divided by 35 = 55 children

Total children toilets and sinks:
Toilets: 5 x 15 = 75 children
Sinks: 9 x 15 = 135 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, climbing equipment
· An adequate amount of cushioning material consisting of wood chips which is in place under the play equipment
· Adequate shade is provide mature trees, canopy, and pop-ups on the patio

Total outdoor activity space was measure and is as follows:
Preschool Playground: 78 x 44 = 3,432 sqft.
Patio: : 38 x 18= 684 sqft
Total: 4,116 sqft divided by 75 = 55 children

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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: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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: TRABUCO PRESBYTERIAN CHURCH PRESCHOOL	FACILITY NUMBER: 304371535
	VISIT DATE: 10/06/2021

NARRATIVE

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A license will be issued for the capacity of 55 after a final review. The facility representative will be notified if any additional information is required.

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.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC809 (FAS) - (06/04)

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