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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371497
Report Date: 06/03/2021
Date Signed: 06/03/2021 11:41:09 AM

Document Has Been Signed on 06/03/2021 11:41 AM - 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:INFLUENCE ACADEMY PRESCHOOLFACILITY NUMBER:
304371497
ADMINISTRATOR:STARK, MICHELEFACILITY TYPE:
850
ADDRESS:8163 EAST KAISER BLVD.TELEPHONE:
(714) 998-8638
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY: 43TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Michele Stark, DirectorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an onsite prelicensing inspection at this proposed childcare center. LPA met with Michele Stark and toured the center. The facility representative has requested to provide care and supervision for children 2 to 6 years of age, Monday through Friday, 7:00 a.m. to 6:00 p.m. in classrooms: 2-year-old, 3-year-old, and 4-year-old. 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.

Director’s office area is located next to the 3-year old classroom and will serve as the isolation area for ill children temporarily until parents arrive. The staff/adult restroom will be used as the isolation restroom for ill children and is conveniently located to the isolation area. Medication will be stored in the director’s office, in a locked file cabinet. Medication administration forms were reviewed. First Aid supplies were inspected and are stored in each classroom. EMSA approved Pediatric CPR & First Aid are current for the director and expires on 11/2022. Facility representative completed the 8-hour Preventative Health Practices, Nutrition, and Lead Poisoning Course with A-B-CPR in November 2022.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2021
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: INFLUENCE ACADEMY PRESCHOOL
FACILITY NUMBER: 304371497
VISIT DATE: 06/03/2021
NARRATIVE
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The following were inspected in the indoor activity space:
Classroom are adequately equipped with age and size appropriate furniture and equipment
Drinking water is available inside by a filter no touch re-fillable fountain
Sign in/Sign out procedure was reviewed and meets regulation requirements
There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements
Cubbies available for storage of individual child’s personal belongings and/or bedding
Napping equipment shall be stored in the director’s office when not in use
Bedding will be taken home by the parents every Friday or end of their scheduled week

Center policy is that AM/PM snacks are by the center. Snacks are individual packaged. Evaluator reviewed Title 22 Sections 101227 with applicant and that the licensee is ultimately responsible to provide adequate, nourishing food.

LPA discussed the posting requirements including, but limited to, the following:
Facility License in public area (101160)
Emergency Disaster Plan (LIC 610)
Earthquake Preparedness Check List (LIC 9148)
Parents’ Rights Poster (PUB 393)
Personal Rights (LIC 613A)
Menus
Activity Schedule
Notice of Site Visit (LIC 9213) and Type A deficiencies
Plan of Corrections of Type A deficiencies
Granted Waivers (available for review)
Child Car Seat Law (PUB 269)
Sudden Infant Death Syndrome Poster (recommended)
Shaken Baby Syndrome Poster (recommended)

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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: INFLUENCE ACADEMY PRESCHOOL
FACILITY NUMBER: 304371497
VISIT DATE: 06/03/2021
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The indoor activity space was measured and is as follows:
2-year-old: 24.09 x 11.11 = 267.63 sqft
3-year-old: 28.03 x 25.11 = 703.83 sqft
4-year-old: 32.10 x 23.05 = 739.90 sqft
Total: 1,711.36 sqft divided by 35 = 48 children

Total children toilets and sinks:
Toilets: 4 x 15 = 60 children
Sinks: 5 x 15 = 75 children

LPA discussed with the facility representative that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Facility representative was advised the children's bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the outdoor activity space:
Playground is fully enclosed by an appropriate fencing
Drinking water is available outdoors by individual water bottles or sippy cups
Outdoor activity space is supplied with age and size appropriate equipment, including play structure with a slide
An adequate amount of cushioning material consisting of soft play foam mat is in place under the play equipment
Adequate shade is provided by shade sails

Total outdoor activity space was measure and is as follows:
Playground: 58 x 24 = 1,392 sqft
Total: 1,392 sqft. divided by 75 = 18 children

The facility has requested a waiver for shared outdoor activity. Per facility representative, each classroom will participate in outdoor activity on a rotating basis.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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: INFLUENCE ACADEMY PRESCHOOL
FACILITY NUMBER: 304371497
VISIT DATE: 06/03/2021
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The facility representative was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Facility representative was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to download forms, Title 22 regulations, and trainings on-line at www.ccld.ca.gov. The facility representative was also informed to visit the website for Quarterly Updates. The facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or at www.ccld.ca.gov

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

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
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: INFLUENCE ACADEMY PRESCHOOL
FACILITY NUMBER: 304371497
VISIT DATE: 06/03/2021
NARRATIVE
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The facility was in compliance with Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has sufficient indoor activity space to support the capacity of 43. However, limited factor for capacity is outdoor activity space.

Prior to licensing the following documents must be submitted to the licensing office by the due date of 06/11/2021:
1. Waiver requesting to share the outdoor activity space on a rotating schedule

The facility representative will be notified if any additional information is required. After final review a license will be issued.

Facility representative was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days

End of Report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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