<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270725
Report Date: 06/28/2022
Date Signed: 06/28/2022 11:04:10 AM

Document Has Been Signed on 06/28/2022 11:04 AM - 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:SAUSD/MONTE VISTA ELEMENTARYFACILITY NUMBER:
304270725
ADMINISTRATOR:ORLANDO, KEELYFACILITY TYPE:
850
ADDRESS:2116 WEST MONTA VISTA AVENUETELEPHONE:
(714) 564-8585
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 0DATE:
06/28/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ms. Berber, Veronica Early Education specialist. TIME COMPLETED:
11:15 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) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection at the above facility for the purpose of Increasing the Preschool capacity in the current licensed rooms # 8.9, 45 and 46 from 74 children. Facility is requesting to increase the capacity to 96 children.
The facility is currently licensed for 74 preschool children. LPA Desai, Ketki met with Early Education Specialist Ms. Berber, Veronica who guided analyst on a tour of the facility. The facility is located on the Monte vista Elementary school under Santa Ana Unified School district. Due to summer break, there were no children present in any of the classrooms.
Currently the facility is operating from 8.00 am to 4.00 PM, Monday to Friday serving children ages 2-5 years old. Facility has a letter from the School board approving the use of the designated classrooms and for children to use the school designated Boys and Girls bathrooms and the Play yards.

Facility shall offer a full day program in Room # 9, 45 and 46 from 8.00 am - 4.00 PM. Children attending Full day session shall be served Breakfast/ Lunch and a PM snack and napping shall be offered. All napping items are provided by the facility and the linens/blankets are taken home for wash on a weekly basis.

Two half day sessions shall be offered in Room # 8 only . (AM session 8-11 am where Breakfast shall be served and PM session 12.00 to 3.00pm :lunch shall be served. There will be no napping in the half day session)

A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the nurse’s office, next to the school office, away from the other children, there is also a bathroom located in this area for the ill children to use. Continue on next page (1 of 2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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 3
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: SAUSD/MONTE VISTA ELEMENTARY
FACILITY NUMBER: 304270725
VISIT DATE: 06/28/2022
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
26
27
28
29
30
31
32
Medication will be stored in the classroom, located in a top cabinet. Incidental Medical services are provided. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. The facility provide water inside/outside by a water jug and disposal cups and children bring their own water bottles from home labeled with their names. First Aid supplies were inventoried.

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

Following was observed in all the four classrooms (8, 9, 45 and 46)
1) Age appropriate furniture and activities including Educational / Arts & Crafts items.
2) Room is well ventilated with proper lighting and shade.
3) There is a working Smoke detector / Carbon Monoxide detectors and Fire Extinguisher.
4) There are toilets and sinks inside the classroom # 45 and 46 only
5) Children shall nap on the cots, linens and blankets are provided by the facility.
6) Parent drop off - pick up: Designated gate in front of the office. Electronic sign in using a specific Pin number and manual sign in also available.
7) There is storage room and kitchen area in room # 46 and this area is off limits to children.

Indoor activity space: 3217'37 divided by 35= 91'92 ( 92 children): Facility has limited indoor activity space to accommodate the requested capacity of 96 children. Based on today's indoor measurement, facility can accommodate only 92 preschool age children in the 4 assigned classrooms. (8,9 ,45 and 46)

Total sinks : 11 X 15 = 165 children / Toilets: 14 x15= 210 children ( Additional sinks and toilets are available on school campus. There are designated toilets and sinks for the preschool age children inside the bathrooms)

Outdoor Activity Space: Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment. Adequate shade is provided by Canopies and trees. The play yard shall be shared with the Kindergarten and Spacial Aid education program children.
(2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: SAUSD/MONTE VISTA ELEMENTARY
FACILITY NUMBER: 304270725
VISIT DATE: 06/28/2022
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
26
27
28
29
30
31
32
Fire clearance approval letter on file and dated 06/23/2022, approving the requested capacity.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

New License with a capacity of 92 preschool age children (2-5 years) in Room # 8, 9,45 and 46.
Monday To Friday 8.00 am - 4.00 P .
Room # 8 : Two half day sessions (8-11 am & PM session: 12.00 to 3.00 PM)
Full day session Room # 9,45 and 46 : 8.00 am to 4.00 PM
Above license shall be issued upon Management approval.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3