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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370398
Report Date: 07/18/2022
Date Signed: 07/18/2022 01:06:30 PM

Document Has Been Signed on 07/18/2022 01:06 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ANAHEIM CITY SCHOOL DISTRICT-HERMOSA VILLAGEFACILITY NUMBER:
304370398
ADMINISTRATOR:JELINEK, VIVIANAFACILITY TYPE:
850
ADDRESS:1515 CALLE DEL MARTELEPHONE:
(714) 517-7518
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 15TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/18/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lynda Durand, School Readiness CoordinatorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit to continue the annual inspection commenced 07/13/22. LPA was met and assisted by Lynda Durand School Readiness Coordinator.
LPA and Ms. Durand conducted tour of physical plant which is an Activity Room #1. There is also a separate bathroom dedicated to this room. During today's visit there were no children in attendance. The regular program commences August 8, 2022 Hours are 7:30am to 4:00pm (3 hour sessions, 8:00-11:00 and 12 to 3:00pm). The Site is operating under Title 5 Regulations.

On 07/13/22 LPA toured the playground. Playground is located in a different location (other side of the apartment complex). Staff stated during hours operation they are the only ones who use playground. Playground is completely enclosed by 4 foot high iron fence. Outdoor activity is supplied with age and size appropriate equipment. An adequate amount of cushioning material (rubber foam mat) is in place under the climbing structure.
Classroom is adequately equipped with age and size appropriate furniture and equipment. Water is provided by drinking fountains.
There are no children currently enrolled. LPA viewed Ms. Durand's file since program is not in operation.
Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a childcare if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and within compliance. At least one staff member present possesses current CPR/First Aid certifications, which expires 09/07/2023. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years.
LPA discussed IMS information For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2022
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: ANAHEIM CITY SCHOOL DISTRICT-HERMOSA VILLAGE
FACILITY NUMBER: 304370398
VISIT DATE: 07/18/2022
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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
The director was informed that Licensing Quarterly Updates are available at www.cdss.ca.gov. Director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.cdss.ca.gov

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian


Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The director was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

Important COVID-19 resources and links were provided. 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.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
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: ANAHEIM CITY SCHOOL DISTRICT-HERMOSA VILLAGE
FACILITY NUMBER: 304370398
VISIT DATE: 07/18/2022
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Exit interview conducted and report was reviewed with facility director. Appeal Rights were explained. The facility representative was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the Regional Manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

Documents/Information to be updated and returned to the Licensing Office.
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
- Fire Drill Log

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC809 (FAS) - (06/04)
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