<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371544
Report Date: 03/11/2022
Date Signed: 03/11/2022 02:00:23 PM

Document Has Been Signed on 03/11/2022 02:00 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:CHILDS-PACE FOUNDATION INC., THEFACILITY NUMBER:
304371544
ADMINISTRATOR:LEVERE, JOHNFACILITY TYPE:
850
ADDRESS:1860 ANAHEIM AVENUETELEPHONE:
(714) 557-7777
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
03/11/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Mr. Levere, John & Ms. Olmedo, PatriciaTIME COMPLETED:
02:15 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) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. Facility is now adding the Preschool program. It has a School age program on site.

LPA met with Facility Administrator Mr. Levere John who gave a tour of the Child Care Center. The applicant has requested to provide care and supervision for 24 Pre-school age children 3 to 5 years of age, Monday through Friday 7.30 am. to 1.00 PM. in the assigned one classroom.

The preschool program shall operate only for 180 days as per the Public school calendar. The program shall be closed during all school breaks and holidays. It shall follow the Costa Mesa School district calendar.

The facility is located inside the Down town Recreation center building, surrounded by several city building's including the City of Costa Mesa Library/ Museum and Public parks.

There were no children in care on today's pre-licensing inspection.

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 facility has a side entrance door opening into the classroom and the main entrance of the Downtown recreation building gate to gain access to the classroom . There is a City reception area in the front lobby of the building. Parents can access this entrance to enter the Preschool room, there are signs posted for easy access. The Side door is the designated door to enter children are received here. This door remains closed and it has a alarm box, on the top, if opened accidentally, it will alert the staff by a loud noise. hours. (page-1)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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 6
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: CHILDS-PACE FOUNDATION INC., THE
FACILITY NUMBER: 304371544
VISIT DATE: 03/11/2022
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
Incidental Medical Services (IMS): This facility plans to provide 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.

Emergency First Aid kits are stored in the Director's office next to the exit door. It was checked for all the needed items including tweezers/ scissors and band-aids.


Isolation area is the Director’s office and the sick child shall use the designated adult restroom, located in the kitchen area, there a cot with linens available for the sick child.

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)
· COVID Posters

All the posters are posted on the side wall in the reception area.

Facility Administrator gave a tour of the new center. One preschool room along with several outdoor play areas are designated for Preschool program. This is the classroom also being used by the school age program, after 1:00 pm. The Preschool program shall be operating only till noon time for 180 day, following the Costa Mesa Public school calendar. These program shall be closed during all the Breaks/ Holiday time as the classroom shall be utilized by the School age program. (Page-2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: CHILDS-PACE FOUNDATION INC., THE
FACILITY NUMBER: 304371544
VISIT DATE: 03/11/2022
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
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 through water fountains and personal water bottles, which are refilled as needed.
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual/Electronic sign in and out)
· 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
· Facility shall provide AM snacks daily, it is a half day program, which ends at 11.45 am
There are two fish tanks with turtles and fishes in the off limit area.

LPA measured the indoor preschool room\
Indoor measurements: 683.91 divided by 35= 19 children
Facility does not have sufficient indoor space to accommodate the requested capacity of 24 children.

Total sinks and Toilets
Sinks : 6 X 15= 90 and Toilets: 5 X15= 60 children.
Toilets and sinks are outside the classroom in the open passage area. There is one sink and toilet next to the Director's office in the kitchen area for the sick child and two sinks with water fountain in the classroom area for easy access. There are additional sinks and toilets in the recreation building and City of Costa Mesa have given the needed permission to use the premises.
Facility has sufficient sinks and toilets to accommodate the requested capacity.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing, it will be accessed from the side walk of the classroom.
· Drinking water is available outdoors by water pitchers and personal water bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures, in the Airplane play yard area.
Preschool children shall also use the Gym area for activities as needed. (Page-3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: CHILDS-PACE FOUNDATION INC., THE
FACILITY NUMBER: 304371544
VISIT DATE: 03/11/2022
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 adequate amount of cushioning material consisting soft cushion is in place under the play structures. The play structure is on the Airplane play yard. This yard is a public park but the climbing structures are in an enclosed area.
· Adequate shade is provided by large trees and structure shade. The side yard is huge, completely enclosed.

Outdoor measurements : Preschool children shall have access to all the surrounding play yards and the enclosed Gym area in the Downtown Recreation center.
Total outdoor activity space: 39578.00 divided by 75 = 527 children

Based on the indoor and outdoor measurements, sink and toilet availability, facility has enough space to accommodate only 19 preschool age children in the designated one preschool classroom . Limiting factor is the indoor activity space.

Fire clearance received from City of Costa Mesa Fire Prevention office dated 12/14/2021 approving the requested capacity.

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through 2/28/2024 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component)

Applicant, Mr.Levere, John were 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: CHILDS-PACE FOUNDATION INC., THE
FACILITY NUMBER: 304371544
VISIT DATE: 03/11/2022
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
Safe Sleep

LPA discussed the safe sleep regulations with applicant Mr. Levere, John discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Review of records to be maintained

LPA reviewed with Applicant Mr. Levere, John the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Subscribe to CCLD important information

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.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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 following Title 22 requirements at the time of the inspection.

Based on today’s measurements, and the sink and toilet availability, this center has enough activity space to support only 19 preschool age children (3-5 years old) in the one assigned classroom.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: CHILDS-PACE FOUNDATION INC., THE
FACILITY NUMBER: 304371544
VISIT DATE: 03/11/2022
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
A license will be issued for the capacity of 19 preschool children age 3-5 years old, Monday to Friday 7.30 to 1:00 PM after a final review.
The Program shall operate only for 180 days per School calendar year. Preschool program shall not be operating during School breaks and Holidays.

The applicant will be notified if any additional information is required.

Exit interview conducted and report was reviewed with the Applicant Mr. Levere, John

Appeal rights were presented to the applicant.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6