304371581-9-28-2022-06-CC-KDEI-CJQ366-20220928175749

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371581
Report Date: 09/28/2022
Date Signed: 09/28/2022 05:59:18 PM

Document Has Been Signed on 09/28/2022 05:59 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:	PIPER IRVINE LLC.		FACILITY NUMBER:	304371581
ADMINISTRATOR:	SIEM, CLAUDIA		FACILITY TYPE:	850
ADDRESS:	8673 IRVINE CENTER DRIVE		TELEPHONE:	(310) 451-4600
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY: 192	TOTAL ENROLLED CHILDREN: 192	CENSUS: 0	DATE:	09/28/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Administrator Ms.Siem, Claudia &Director of Operation's Ms. Vanderstay, Rochelle		TIME COMPLETED:	06:00 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) Desai, Ketki conducted an announced Pre-Licensing inspection at the above facility. It is a Change of Ownership, facility was granted an Emergency Approval to operate valid up to October 5th 2022. LPA met with the Applicant / Administrator Ms. Siem, Claudia along with Director of Operations of Piper preschool Ms. Vanderstay, Rachelle, who gave a tour of the facility. The facility is requesting care and supervision to be provided for 192 Preschool age children (2-6 years) Monday to Friday (8.00 to 6.00 PM) in the assigned nine classrooms. ( Room # 1 to 9). Facility is on a business complex, with assigned parking space with limited time space for Drop off and Pick up only. LPA observed staff following CDC and Dept of Public Health Guidelines. Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements. 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. Parents shall enter through the main door with a Ring lock pad , upon ringing the bell, parents shall obtain access into the facility by the staff , it opens into the main lobby area where children and the parents shall be guided into the individual classrooms. Parents shall sign in Electronically using the Bright Wheel application. A sign in table has been set up, at the side of the Lobby area outside the Director's office. Upon arrival each child has an health evaluation along with hand washing before they participate in the activities. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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: PIPER IRVINE LLC.	FACILITY NUMBER: 304371581
	VISIT DATE: 09/28/2022

NARRATIVE

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Isolation area is the Director's office located on the left side of the entrance door, which is off limits and Administrator has been set up an area to isolate the child. Separate mat and linens are 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.
Posters are posted on the side wall of the passage area leading into the classrooms

The following were inspected in the indoor activity space: (Room # 1 to 9)
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through personalized water bottles and water fountain in the classroom
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Electronic sign in and out)
· Facility has in-built Dual: Smoke detectors & carbon monoxide detectors in the ceiling with Fire Alarms , Sprinkler system and three fire extinguishers mounted in the passage areas that meet statutory requirements.
· Cubbies available for storage for individual child’s personal belongings
· Facility shall provide AM snack and PM snacks, while lunch shall be brought from home.
Rooms are well lighted with proper ventilation

There are age appropriate sinks and toilets inside each classroom with additional toilets and sinks in the facility.
Medications are stored in the locked boxes in the Director's office.
First Aid kit and Emergency kit is present in each of the nine classrooms.
(2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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: PIPER IRVINE LLC.	FACILITY NUMBER: 304371581
	VISIT DATE: 09/28/2022

NARRATIVE

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All the nine classrooms were measured on today's inspection.

Total indoor activity space : 6,489'64 divided by 35 = 185'41 (185 children)

Facility doesn't have space for the requested capacity of 192 children, but has sufficient indoor activity space to accommodate only 185 preschool age children in the assigned nine rooms ( Room # 1 to 9) .

Total sinks : 26 X 15= 390 children / Total Toilets: 17 X 15= 255 children . Each classroom has sinks and toilets inside, with additional adult restrooms on the premises.

Preschool age play yards : Facility has two play yards for preschool children:
· Each Play yard is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by personal water bottles and a water dispenser with dixie cups.
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys.
There is an exit door at the end of the each play yard, this is an Egress exit, Applicant has installed an Alarm bell on the top to alert the staff if the door is accidentally accessed.
· An adequate amount of cushioning material: soft cushion is used to absorb the falls
· Adequate shade is provided by shaded structure and Sails.
· Children shall access the play yard from exit door of the classrooms
The play structure is safe for the age group to be served (2-5 years old)
Sails are used as a shade over the climbing structures and sandboxes.
Sandboxes have tarp covering
Bike trail is surrounding the play yard area.

Total outdoor activity space ( 2 play yards)= 11,594'23 divided by 75 = 154'59 (155 children)

Based on the indoor / outdoor measurements, sink and toilet availability, facility has sufficient space to accommodate only 185 children, in the assigned Nine classrooms (Room # 1 to 9.

Facility shall request a waiver for staggered schedule to accommodate the requested capacity. (3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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: PIPER IRVINE LLC.	FACILITY NUMBER: 304371581
	VISIT DATE: 09/28/2022

NARRATIVE

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Fire clearance received from Orange county Fire Authority has approved the requested capacity.

Administrator on site Ms. Siem, Claudia is current on the required Immunization/ Pediatric CPR/ First training valid through 6/20/2024, and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component and Mandated Child abuse reporting training.

Facility has also completed the Water testing for Lead component.

Following items were discussed at the time of Exit interview.
Criminal Record Statement : Administrator on site Ms. Siem, Claudia 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 Administrator on site Ms. Siem, Claudia 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 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.

Incidental Medical Services (IMS) APPLICANT KNOWS FACILITY PLANS TO PROVIDE 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 (4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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: PIPER IRVINE LLC.	FACILITY NUMBER: 304371581
	VISIT DATE: 09/28/2022

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Review of records to be maintained

Child Care Centers :LPA reviewed with Administrator on site Ms Siem, Claudia 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 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 185 preschool age children (2-6 years) in Preschool Room # 1, 2, 3, 4, 5, 6, 7, 8 and 9

Monday to Friday : 8am to 6.00 pm
Waiver for Staggered schedule for outdoor play .

The above license shall be issued upon Management approval. The report was read and appeal rights were presented to the Administrator on site Ms.Siem, Claudia.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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