300614058-8-23-2023-06-CC-MMAK-CUYTM9-20230823145046

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300614058
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:50:52 PM

Document Has Been Signed on 08/23/2023 02:50 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:	CENTRALIA STATE PRESCHOOL AT DANBROOK		FACILITY NUMBER:	300614058
ADMINISTRATOR:	SUSAN ESTRADA		FACILITY TYPE:	850
ADDRESS:	320 DANBROOK STREET		TELEPHONE:	(714) 228-3239
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 22	DATE:	08/23/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Site Supervisor		TIME COMPLETED:	03:15 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 increasing capacity from 45 children to 48 children by adding Room KA and removing Room C17. Room C17 is occupied by Transitional Kindergarten children from this elementary school. The facility is currently licensed for 45 children in Rooms C17 and KB. LPA met with Site Supervisor, Ana Pineda who gave LPA a tour of the facility. Later on LPA met with Child Development Coordinator Susan Estrada with Centralia School District. There were 22 children present with 4 staff. The licensee has requested to provide care and supervision for 48 preschool children in rooms KA, and KB for ages 2 to 5 years old, Monday through Friday, 8:00 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 Centralia School District). The State Preschool is a Title 5 Program that offers two morning and afternoon sessions. Morning hours are from 8:am to 11:00 am and afternoon sessions are from 11:30 am to 2:30 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 manually. The indoor activity space measurement for the current requested capacity is as follows: Room KA is 1063.12 square feet Room KB is 1063.12 square feet Total indoor measurement is 2126.24 square feet divided by 35 square feet = 60.75 (61 children). Total toilets: 4 X 15- 60 children Total sinks: 4 x 15 = 60 children There are one toilet and 2 sinks in each classrooms. There are 5 toilets, 2 sinks in the girls' bathroom and one toilet, 4 urinals, and sinks in the boys' bathroom. The facility will request a waiver to share the restroom of this elementary site as additional restrooms. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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: CENTRALIA STATE PRESCHOOL AT DANBROOK	FACILITY NUMBER: 300614058
	VISIT DATE: 08/23/2023

NARRATIVE

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Page 2 of 2

The preschool is sharing the playground with TK children. There is a waiver to share playground for this site on file.
New room KA classroom is not equipped with carbon monoxide detector. The site supervisor, Ana Pineda is current on CPR and 1st aid which expires 1/18/2024. LIC 311D was given to the facility representative for list of documents to keep in children's files and staffs' files and posting.

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 48 preschool children.
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, .

Based on today’s measurements, the sinks and toilets availability, the request of the facility for adding room KA and removing room C17 with a capacity of 48 children will be final reviewed and discussed with management in the Regional Office and after receiving the following. The facility will be notified if any additional information is required.

The following are needed before an updated license is issued

1- Waiver request for sharing restrooms. For waiver request, please send request letter, LIC 500, LIC 999, photo of the restroom to show the posting to state "Preschool use".

2- Site supervisor packet for staff # 1. Checklist items were given.

3- Carbon Monoxide in new room KA.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

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