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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371193
Report Date: 05/11/2023
Date Signed: 05/11/2023 03:18:42 PM

Document Has Been Signed on 05/11/2023 03:18 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:NI HAO PRESCHOOL-COSTA MESAFACILITY NUMBER:
304371193
ADMINISTRATOR:JANKI SHAHFACILITY TYPE:
850
ADDRESS:827 W. STEVENS AVETELEPHONE:
(657) 231-6318
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 18DATE:
05/11/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:DirectorTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of increasing the capacity of preschool from 36 children to 54 children without adding any additional space. LPA met with director, Janki Shah who gave LPA a tour of the facility. Census was taken. There were a total of 18 children resting on the cots with 2 staff. Currently the facility is licensed for 36 preschool children ages 2 to 6 years of age in two rooms (Room # 1, Orange Room, and Room # 2, Green Room).
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 Director, Janki Shah was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
The facility has requested to provide care and supervision to 54 preschool children in two rooms.
(Room # 1, Orange Room, and Room # 2, Green Room), Monday to Friday from 7:00 am to 6:00 pm. Children are signed in and out electronically at the entrance of the building to go to assigned rooms. The facility has met all the posting requirements.
According to the measurement of 2/14/2018:
The total indoor activity space measurement for the requested capacity for Room 1 and Room 2 is as follows:
1891.35 divided by 35 = 54.03 (54 children).
Continued on page 2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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: NI HAO PRESCHOOL-COSTA MESA
FACILITY NUMBER: 304371193
VISIT DATE: 05/11/2023
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The total outdoor space for the preschool playground is:
5567 square feet divided by 75 = 74.22 (74 children).
The outdoor activity space is equipped with age appropriate toys and play equipment. There are enough cushioning (Mulch and Turf) under the climbing structures. The playground is all fenced off. There is a gate at the back of the building on the outdoor activity space that is equipped with 2 locks and latch. The director stated this exist gate is always locked and is not used for entering and exiting.

Total children toilets and sinks:
4 toilets X 15 = 60 children
6 sinks X 15 = 90 children

The director, Janki Shah is current with CPR and 1st aid and Mandated Reporter Training.
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

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 director, Janki Shah.

Based on the measurements of indoor, outdoor, availability of toilets and sinks, an updated license for capacity of 54 preschool children ages 2 to 6 years old in two rooms. (Room # 1, Orange Room, and Room # 2, Green Room), Monday to Friday from 7:00 am to 6:00 pm will be issued after final review and management approval. The facility will be notified if additional documents are needed.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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