300613937-8-7-2023-06-CC-MMAK-CUGS9U-20230807134120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300613937
Report Date: 08/06/2023
Date Signed: 08/07/2023 01:41:24 PM

Document Has Been Signed on 08/07/2023 01:41 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	ANAHEIM ELEMENTARY SCHOOL DISTRICT MANN		FACILITY NUMBER:	300613937
ADMINISTRATOR:	JELINEK, VIVIANA		FACILITY TYPE:	850
ADDRESS:	600 WEST LA PALMA		TELEPHONE:	(714) 517-8727
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92805
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	08/06/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Applicant		TIME COMPLETED:	02:15 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	Page 1 of 2 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of moving from room 57 to room 54. The facility is licensed for 24 children in room 57. The facility is not changing capacity. LPA met with Lynda Durand, School Readiness Coordinator from Office of Early Childhood Education with Anaheim Elementary School District and site supervisor, Laura Cux who toured the facility with LPA. There were no children present. The licensee has requested to provide care and supervision for 24 preschool children in room 54 for ages 2 to 5 years old, Monday through Friday, 7:30 a.m. to 4:00 p.m. 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 staff are employees of Anaheim Elementary School District) The State Preschool is a Title 5 Program that offers two morning and afternoon sessions. Morning hours are from 8:am and afternoon sessions are from 12:00 noon to 3:00 pm. The facility provides morning breakfast and afternoon lunch to children. Children do not nap in this program. The children are dropped off and are singed in and out at the entrance of the gate in the parking lot. The facility has met all the posting requirements. The indoor activity space measurement for the current requested capacity is as follows: Room 54 is 840.60 square feet divided by 35 square feet = 24.01 (24 children). There is one sink in the classroom. There are a total of 2 toilets and one sink inside the restroom in the classroom. The facility had a waiver to share restrooms on this site which will be voided. The preschool is sharing the playground with TK and Kindergarten programs. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ANAHEIM ELEMENTARY SCHOOL DISTRICT MANN	FACILITY NUMBER: 300613937
	VISIT DATE: 08/06/2023

NARRATIVE

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The classroom is equipped with carbon monoxide detector. There is a storage room in this classroom that shall be locked and inaccessible to children.
The site supervisor, Laura Cux is current on CPR and 1st aid which expires 3/2025.
The playground is equipped with climbing structure /slide with adequate of cushioning materials.

Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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
Orange county Fire authority has approved the requested capacity of 24 preschool children in room 54.
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the applicant on file, Lynda Durand.

Based on today’s measurements, the sinks and toilets availability, the request of the facility for moving to room 54 with a total capacity of 24 children will be final reviewed and discussed with management in the Regional Office. The facility will be notified if any additional information is required.

The following are needed before an updated license is issued

1- Securing 4 peaces of furniture in dramatic area such as kitchen, refrigerator, sink, and stove in room 54.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC809 (FAS) - (06/04)

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