304371563-4-6-2023-06-CC-MMAK-CQMT29-20230406142021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371563
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:41:13 PM

Document Has Been Signed on 04/06/2023 04:41 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:	OUR TRIBE OUR VILLAGE CHILDCARE CENTER		FACILITY NUMBER:	304371563
ADMINISTRATOR:	MARIN, QUASHANIKA		FACILITY TYPE:	830
ADDRESS:	6441 LINCOLN AVENUE		TELEPHONE:	(562) 999-6783
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/06/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Applicant/Director		TIME COMPLETED:	02:55 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	Page 1 of 5 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced on site pre-licensing inspection at this childcare center for the purpose of opening an Infant/Toddler Program at this site. The facility runs a preschool as well. The facility is located at Bethel Lutheran Church. LPA met with Applicant/Director, Quashanika Marin. LPA was given a tour by the director of the infant classroom on this combination center. One Infant room (Room # 2) has been designated for Infant care ages birth to 24 months old. The applicant has requested to provide care and supervision for 8 infants (birth to 24 months old) in room # 2, Monday through Friday 7:00 AM. to 6:00 PM. LPA observed the facility following CDC and Dept of Public Health Guidelines. Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements. Parents sign in and out at the entrance of the room electronically. They enter through a gate from the parking lot of the church. Upon arrival each child has an health evaluation along with hand washing before they participate in the activities. Isolation area is the Director’s office, located in the hallway close to the infant room. There is additional cot and crib with beddings available for sick child/children until the parents pick up the sick child/ children. Staff bathroom which is close to the isolation area will be used for sick child/children. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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

FACILITY NAME: OUR TRIBE OUR VILLAGE CHILDCARE CENTER	FACILITY NUMBER: 304371563
	VISIT DATE: 04/06/2023

NARRATIVE

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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, and Safe sleep posters / SIDS.
The following was observed in the Infant room # 2
Age appropriate furniture, toys, and equipment. An equipment which was not approved by the Department from the family of walkers and a rocker were removed from the classroom during inspection.
Room is well lighted with ventilation. Infant room has a napping area with cribs separated by few shelves. The partition is in order. There is sufficient open area for the child to move in the activity area.
Changing table is placed inside the napping area in the classroom and within the arm's length of a sink, LPA discussed the positioning of the changing table for visual observation of children. The diaper changing table has padded surface no less than one inch tick with washable vinyl. It has raised sides on four sides at least 3 inches high. The changing table was against the wall facing staff to the wall. During inspection this position was discussed with the director and changed around so staff can have visual observation of other children when changing diapers. The diaper changing steps was posted and discussed with director.
Storage cubbies are arranged to store personal belongings
There are 6 cribs in the napping area with mattress and sheets. LPA observed the sheets were not tight fitted enough. During inspection this was taken care of by providing sheet grippers attaching them to the bottom of the sheet under the mattresses to make them fitted. Cots are available for older children. Beddings are washed at the facility on a daily basis. One crib shall be used by one infant at a time only. Flooring is wood and there is a foam carpet on the floor of the activity area. There is a Refrigerator in the classroom to store the milk and other items. LPA reminded the director that all the food shall be labeled with the child's name and date.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: OUR TRIBE OUR VILLAGE CHILDCARE CENTER	FACILITY NUMBER: 304371563
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA discussed the Safe sleep practice with the director, Quashanika Marin.

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.

LPA measured the assigned Room (Infant Room # 2)
Infant Room # 2 is 375.90 square feet
Napping area which was included in the calculation is 287.22 square feet
Total Indoor activity space : 375.90 square feet divided by 35 = 10.74 (11 children).
Total sinks: 6 X 15= 90 children (There are 5 sinks in the restroom area for the preschool and infant program and one sink in the infant room)
Total toilets: 3 X 15 = 45 children ( There are 3 toilets in the restroom area for the preschool and infant program). There are 3 urinals in this room as well.
The facility has requested for 8 infants. The infant room can accommodate the required capacity. Infant/toddler outdoor play yard : Facility has designated Infant/toddler yard which is all fenced to share with Toddler Option children. Waiver is required.
Playground is fully enclosed by an appropriate fencing, Outdoor activity space is supplied with age and size appropriate equipment, and outdoor activity toys. The area is covered with turf with adequate cushioning. Shade is provided by awning. The facility will send a waiver request to share the playground with Toddler Option children on different scheduling.
Outdoor activity space: 1007 square feet divided by 75 = 13.43 (13 children)
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: OUR TRIBE OUR VILLAGE CHILDCARE CENTER	FACILITY NUMBER: 304371563
	VISIT DATE: 04/06/2023

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Facility has sufficient space to accommodate the requested capacity of 8 the designated yard.
Fire clearance received from Orange County Fire Authority approving the requested capacity of 8 infants in room # 2.
The director, Quashanika Marin is current on the required Immunization/ Pediatric CPR/ First training and has provided the completion certificate for the Preventive Health training (Nutrition and Lead component) and Mandated Child abuse reporting training.
Following items were discussed at the time of Exit interview.
Criminal Record Statement : The Director, Quashanika Marin 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.
Safe Sleep LPA discussed the safe sleep regulations with director, Quashanika Marin and 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 the director, Quashanika Marin 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.
The director was reminded of additional LIC form (LIC 9227) to be filled out by parents of children under 12 months old. Also she was reminded of checking of infants every 15 minutes during nap time. A sample log was given to the director for this matter.
Incidental Medical Services Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: OUR TRIBE OUR VILLAGE CHILDCARE CENTER	FACILITY NUMBER: 304371563
	VISIT DATE: 04/06/2023

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Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Child Care Centers : LPA reviewed the LIC 311A, Records to Be Maintained at the Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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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 license 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. 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.

A license for a total of 8 infants and toddlers, ages birth to 24 months old in Room # 2, Monday to Friday 7.00 am to 6:00 PM will be issued upon receiving the following corrections and Management approval. The applicant will be notified if any additional documents are needed before issuing a license. On today's inspection, the director submitted/corrected additional documents to LPA which requested.

(1) Providing partition for infant/toddler room (Room # 2) to separate the napping area from activity area. The patrician shall be at least 4 feet high and shall be constructed of sound absorbing material and shall be designed to minimize the risk of injury of infants.

(2) Waiver approval from the Department to share the outdoor space with toddler option on different scheduling. The director submitted LIC 999, LIC 500, outdoor scheduling, and photo of the outdoor space to LPA during inspection.

(3) Association of Applicant and staff to the Infant/toddler program..
Exit interview conducted and report was reviewed with the director, Quashanika Marin.
End of reports

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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