304371520-9-7-2021-06-CC-STOE-C6MQDA-20210907120426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371520
Report Date: 09/07/2021
Date Signed: 09/07/2021 12:04:35 PM

Document Has Been Signed on 09/07/2021 12:04 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 DISCOVERY CHRISTIAN SCHOOL		FACILITY NUMBER:	304371520
ADMINISTRATOR:	GAUVAIN, KIM		FACILITY TYPE:	840
ADDRESS:	1275 EAST BROADWAY STREET		TELEPHONE:	(714) 502-4163
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92805
CAPACITY: 25	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Kim Gauvain, Director		TIME COMPLETED:	12:10 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	Licensing Program Analyst (LPA) Stacy Torrence conducted an onsite prelicensing visit at this proposed childcare center, for the purpose of adding a school-age component. LPA met with Director Kim Gauvain, who guided analyst on a tour of the center. The applicant has requested to provide care and supervision for 25 school-age children; ages 7 to 12 years old, Monday through Friday, 7:00 a.m. to 6:00 p.m. In classrooms: #102, #105, and Multipurpose Room (MPR). 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 children shall have access through the main entrance of the facility. Parents will escort children inside the facility to sign in/out and walk them through the hallway where their classrooms are located. Office area is located in the front of the building 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, located on top of the refrigerator, in locked boxes. Medication administration forms were reviewed. First Aid supplies were inspected and are stored inside each classroom and one outside on the playground. EMSA approved Pediatric CPR & First Aid are current for the director and expires on 08/2023. 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. Continue on next page (1 of 4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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: ANAHEIM DISCOVERY CHRISTIAN SCHOOL	FACILITY NUMBER: 304371520
	VISIT DATE: 09/07/2021

NARRATIVE

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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 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 children bringing their bottles from home/water pitcher also available for re-fills
· 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

Center policy is that lunch, AM, and PM snacks are provided. Evaluator reviewed Title 22 Sections 101227 with applicant and that the licensee is ultimately responsible to provide adequate, nourishing food.

The indoor activity space was measured and is as follows:
Room #102: 23.01 x 16.05 = 369 sqft
Room #105: 24.03 x 16.02 = 384 sqft
MPR: 48.05 x 37.09 = 1,782 sqft
Total= 2,535 sqft divided by 35 = 72 children

Total children toilets and sinks:
Toilets: 6 X 15 = 90 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.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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: ANAHEIM DISCOVERY CHRISTIAN SCHOOL	FACILITY NUMBER: 304371520
	VISIT DATE: 09/07/2021

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The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available by children bringing their bottles from home and a water dispenser with cold water is available re-fill, and there's disposal cups available.
· Outdoor activity space is supplied with age and size appropriate equipment
· An adequate amount of cushioning material consisting of grass which is in place under the play equipment
· Adequate shade is provided by trees and umbrellas

Total outdoor activity space was measure and is as follows:
School-Age Playground: 94.00 x 67.00 = 6,298 sqft.
Total: 6,298 sqft divided by 75 = 83 children

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

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 activity space to support the capacity of 25. A license will be issued for the capacity of 25 after a final review. The applicant will be notified if any additional information is required.

Applicant 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

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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 DISCOVERY CHRISTIAN SCHOOL	FACILITY NUMBER: 304371520
	VISIT DATE: 09/07/2021

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 26 27 28 29 30 31 32	An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The applicant 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: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

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