304371253-7-9-2024-06-CC-ASIA-D6ZTZ2-20240709150938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371253
Report Date: 07/09/2024
Date Signed: 07/09/2024 03:12:53 PM

Document Has Been Signed on 07/09/2024 03:12 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:	APPLE TREE PRESCHOOL & KINDERGARTEN		FACILITY NUMBER:	304371253
ADMINISTRATOR:	PERANCULLO, MARBEN		FACILITY TYPE:	830
ADDRESS:	2211 WEST WOODLEY AVENUE		TELEPHONE:	(714) 772-1005
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92801
CAPACITY:	30	CENSUS: 26	DATE:	07/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:53 PM
MET WITH:	Ishara Silva		TIME COMPLETED:	03:30 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	On 7/9/2024, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Annual/Random inspection assisted by Director Ishara Silva. Upon arrival, total census was 26, including 9 infants and 17 toddlers, supervised by qualified staff. The facility was operating within ratios and capacity. Facility hours are 6:30 AM to 6:00 PM, Monday through Friday. An on-site Facility Personnel Report Summary review showed that all facility staff or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions. The LPA inspected the indoor areas and areas accessible to clients at the time of the visit. The facility was equipped with smoke and carbon monoxide detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. Records show the last disaster drill was conducted on June 30, 2024. The director stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. No poisons or other items that could pose a danger to clients were observed during the inspection. The facility provides age-appropriate toys, play equipment, and materials for the clients served. The facility meets all posting requirements. OUTDOOR INSPECTION. The LPA inspected the outdoor areas. The playground was enclosed by a fence at least four feet in height and is in good repair. At the time of inspection, the surface of the outdoor activity area was maintained and free of any observable hazards. The areas around and under high climbing equipment, swings, slides, and other similar equipment were cushioned with material that absorbs falls. The outdoor equipment and toys are in good repair and free of sharp edges.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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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Document Has Been Signed on 07/09/2024 03:12 PM - It Cannot Be Edited

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: APPLE TREE PRESCHOOL & KINDERGARTEN	FACILITY NUMBER: 304371253
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type B

Section Cited

CCR

101430(a)(3)(A)(4)(a)

Infant Care Activities

(A) Staff shall place infants up to 12-months of age on their backs for sleeping. (4) Infants with an Individual Infant Sleeping Plan [LIC 9227 (3/20)] that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep. In the event the infant changes position, the infant may remain in the alternative position. (a) Upon staff observation that the infant is capable of rolling from their back to their stomach and stomach to their back, the provider shall fill out Section D of the Individual Infant Sleeping Plan [LIC 9227 (3/20)], notify the authorized representative, and obtain the authorized representative's signature on the individual sleeping plan no later than the next business day following observation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, the licensee did not comply with the section cited above in two of two infants under twelve months old who did not have an LIC9227, which poses/posed a potential health, safety or personal rights risk to persons in care. The two infant files did not have an LIC9227; both infants were under 12 months old.
	POC Due Date: 08/06/2024
	Plan of Correction
1 2 3 4	The director stated she will obtain signed LIC9227 forms for the two infants and will update the infant enrollment packet to prevent this from happening in the future.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN	FACILITY NUMBER: 304371253
	VISIT DATE: 07/09/2024

NARRATIVE

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Files were checked for compliance. Based on a records review, two infants under 12 months did not have a LIC9227 Individualized Infant Sleeping plan in file (See 809D).

Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states a person shall not be employed or volunteer at a child day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, and measles for staff members were reviewed and within compliance. 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. Staff present had a currently mandated reporter. Staff files were reviewed for compliance. At least one staff present has a valid EMSA approved Pediatric CPR/First Aid certification that expires in 2025.

The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. When any IMS is provided, a Plan for Providing 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 the 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

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN	FACILITY NUMBER: 304371253
	VISIT DATE: 07/09/2024

NARRATIVE

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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 facility representative 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.

LEAD TESTING: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every
5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Based on records, the school completed a lead test in 12/2022.

CRIMINAL RECORD CLEARANCE: The director understands that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN	FACILITY NUMBER: 304371253
	VISIT DATE: 07/09/2024

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The facility was not in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed and cited: Infant Care Activities 101430(a)(3)(A)(4)(a).

Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and the report was reviewed with the director.

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.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo Silva	TELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC809 (FAS) - (06/04)

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