304270776-8-7-2023-06-CC-MMAK-CUGS94-20230807134007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270776
Report Date: 08/07/2023
Date Signed: 08/07/2023 01:40:12 PM

Document Has Been Signed on 08/07/2023 01:40 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 MADISON		FACILITY NUMBER:	304270776
ADMINISTRATOR:	APINDER KAUR		FACILITY TYPE:	850
ADDRESS:	1510 SOUTH NUTWOOD STREET		TELEPHONE:	(714) 517-8935
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 0	DATE:	08/07/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Applicant		TIME COMPLETED:	12:00 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 and adding one more room. The facility is licensed for 23 children in Module 2. The facility is changing capacity from 23 children to 45 children in two rooms. LPA met with Lynda Durand, School Readiness Coordinator from Office of Early Childhood Education with Anaheim Elementary School District and site supervisor, Apinder Kaur who toured the facility with LPA. There were no children present. The licensee has requested to provide care and supervision for 45 preschool children in rooms PS1 and PS2 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. The facility has met all the posting requirements. The indoor activity space measurement for the current requested capacity is as follows: Room PS1 is 777.82 square feet divided by 35 square feet = 22 children. Room PSA is 805 square feet divided by 35 square feet = 23 children. Total indoor measurement for Room PS1 and PS2 are 1582.82 square feet divided by 35 square feet = 45.22 (45 children). There is one sink in the classroom. There are a total of 3 toilets and 3 sinks inside the classrooms The preschool is not sharing the playground with any other programs. Continued on page 2

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

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 MADISON	FACILITY NUMBER: 304270776
	VISIT DATE: 08/07/2023

NARRATIVE

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Total outdoor activity space measurement is as follows: Outdoor space in front of the classrooms: 6400 square feet divided 75 sq feet = 85.33 (85 children).
A waiver is on file for main streaming with inclusion program.
The classroom is equipped with carbon monoxide detector. The site supervisor, Apinder Kaur 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 45 preschool children in rooms PS1 and PS2.
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 Rooms PS1 and PS2 with a total capacity of 45 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 both rooms PS1 and PS2.

2- Final picture of classroom set up for room PS2.

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)

Page: 2 of 2