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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370948
Report Date: 06/28/2022
Date Signed: 06/28/2022 04:09:14 PM

Document Has Been Signed on 06/28/2022 04:09 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:SAUSD/EDISON ELEMENTARYFACILITY NUMBER:
304370948
ADMINISTRATOR:ORLANDO, KEELYFACILITY TYPE:
850
ADDRESS:2063 ORANGE AVENUETELEPHONE:
(714) 569-3599
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
06/28/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Ms. Berber, Veronica Early Education Specialist.TIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Desai, Ketki conducted an unannounced Case Management Licensee initiated inspection at the above facility for the purpose of Decreasing the Preschool capacity by removing one of the Licensed room # 403. Facility is requesting the capacity to 48 children.

The facility is currently licensed for 60 preschool children in Room # 401/ 402 and 403.
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 Edison 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 offering two half day sessions in both the licensed rooms.
Facility has a Waiver to use the School yards and bathrooms on file.

Facility shall continue to offer full day session in Room # 402 from 8.00 am to 4.00 PM and half day session in room # 401, (AM session 8- 11 am where Breakfast shall be served and PM session 12.00 to 3.00 PM: 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/EDISON ELEMENTARY
FACILITY NUMBER: 304370948
VISIT DATE: 06/28/2022
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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 provides breakfast for AM session and Lunch for the afternoon session, all food is delivered to the the facility by the school district cafeteria.

Following was observed in all the current classroom # 401 and 402
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 age appropriate toilets and sinks outside the classroom.
5) Parent drop off - pick up: Designated gate next to the school administrative office . Electronic sign in using a specific Pin number and manual sign in also available.
6) There is one toilet and 2 sinks in each classroom and additional bathrooms across the classroom are available for preschool age children.
7) In fullday session children nap on the cots, linens and blankets are provided by the facility and washed on the weekly basis by the parents.

Indoor activity space: 2573'90 divided by 35= 73'54 (74 children) Facility has sufficient space to accommodate the requested capacity of 48 preschool age children in Room # 401 and 402.

Total sinks : 4 x 15= 60 and 2 X 15 = 30 inside the classroom and Additional sinks and toilets are available on school campus. Facility has an approved Waiver on file to share the school bathrooms and play yards.

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 Special Aid education program children. Waiver on file.
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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/EDISON ELEMENTARY
FACILITY NUMBER: 304370948
VISIT DATE: 06/28/2022
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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 48 preschool age children (2-5 years) in Room # 401 and 402
Monday To Friday 8.00 am - 4.00 PM .
Room # 402: Full day session : 8.00 am to 4.00 PM
Room # 401: half day sessions (8- 11.00 am & PM session: 12.00 to 3.00 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)
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