304371632-7-24-2023-06-CC-MMAK-CU2QX4-20230724123252

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371632
Report Date: 07/24/2023
Date Signed: 07/24/2023 12:32:58 PM

Document Has Been Signed on 07/24/2023 12:32 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:	DRAGONFLY ACADEMY		FACILITY NUMBER:	304371632
ADMINISTRATOR:	NGUYEN, VICKIE		FACILITY TYPE:	850
ADDRESS:	8762 GARDEN GROVE BLVD. # 102		TELEPHONE:	(657) 280-9093
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92844
CAPACITY: 65	TOTAL ENROLLED CHILDREN: 65	CENSUS: 0	DATE:	07/24/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant and director		TIME COMPLETED:	01:00 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	Page 1 of 4 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced on site pre-licensing inspection at this childcare center for the purpose of operating a preschool program at this site. LPA met with the applicant, Phong Chau, and director Vickie Nguyen who gave a tour of the entire facility to LPA. There are 5 classrooms which have been designated for preschool children ages 2 to 5 years old. The applicant has requested to provide care and supervision for 65 preschool children ages 2 to 5 years old in 5 classrooms, Monday through Friday from 7:30 am to 6:00 pm. Parents sign their children in and out at the entrance of the building in the office area. Upon arrival each child has a health evaluation along with hand washing before they participate in the activities. Isolation area is the Director’s office, located at the entrance of the building. There is additional cot with beddings available for the sick child in an area adjacent to the director's office until the parents pick up the sick child/ren. There is staff bathroom close to this area to be used for sick child/ren temporarily. LPA reminded the director one staff person shall supervise the sick child until picked up. 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) · 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) Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: DRAGONFLY ACADEMY	FACILITY NUMBER: 304371632
	VISIT DATE: 07/24/2023

NARRATIVE

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· Child Car Seat Law (PUB 269) .
Safe sleep posters / SIDS

The following was observed in 5 classrooms:
Age appropriate furniture, toys, and equipment.
Rooms are well lighted with ventilation.
There is sufficient open area for the child to move.
Storage cubbies are arranged to store personal belongings
Flooring is wood.
Morning and afternoon snacks and lunches are provided by the facility. The facility will cater food for children. Director stated they might prepare food in the kitchen area for children. LPA reminded the director that kitchen area shall be inaccessible to children. There is a lock on the door.
Water is provided in the children's water containers with their names on them. The facility refills filtered water for children if needed.
Children sleep on cots. Beddings are provided by parents and are kept at the facility in individual area and are sent home to be washed on a weekly basis.
LPA measured the assigned rooms for preschool:

Room # 1 is measured 305.91 square feet
Room # 2 is measured 393.11 square feet
Room # 3 is measured 416.36 square feet. There was a diaper changing table in this room which did not meet Title 22 Regulations. The diaper changing table was removed during LPA's inspection. The director stated the classroom is designed for 2 year old children and they will be changed in the bathroom located in the classroom on a mat on the floor if needed.
Room # 4 is measured 418.60 square feet
Room # 5 is measured 551.93 square feet.
Room # 4 and Room # 5 have been separated by a secured wooden partician from each other.

Continued on page 3

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: DRAGONFLY ACADEMY	FACILITY NUMBER: 304371632
	VISIT DATE: 07/24/2023

NARRATIVE

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Total indoor activity measurement is:1796.89 square feet divided by 35 square feet = 51.34
(51 children).
There is one sink located in each classroom.
Total sinks: 8 X 15= 120 children
Total toilet: 6 X 15 = 90 children
Outdoor activity space is: 5083.06 square feet divided by 75 =67.77 (68 children) .
Outdoor space for preschool children is fully enclosed by an appropriate fencing, Outdoor activity space is supplied with age and size appropriate equipment, outdoor toys, and bikes. There is a high play structure on the outdoor activity space for preschool children with slide and swings with adequate cushioning (Rubber) around and under the falling zones. The facility has separated the outdoor activity area for younger children and older children. There are two sliding fences that have separated the area. There is one area for bike riding. The sliding fence opening to the parking lot is locked by a padlock. There are two entrances on the playground leading to upstairs area which are gated and locked by two locks. The director was reminded they shall be locked at all times.
Fire clearance received from Orange County Fire Authority approving the capacity for 54 children. Today's measurements of the facility had enough indoor capacity for 51 children.
The director, Vickie Nguyen 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.
The facility representative, applicant Phong Chau. and director Vickie Nguyen were 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

LPA also informed the director, Vickie Nguyen 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
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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

FACILITY NAME: DRAGONFLY ACADEMY	FACILITY NUMBER: 304371632
	VISIT DATE: 07/24/2023

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recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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) or (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.
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.
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 platforms.
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. The facility representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the inspection, some corrections such as securing the children's kitchen toys, bookshelves, and tall cabinet in the classrooms were secured.
The facility representatives were reminded of lead water testing. Related PINs were given to applicant.

Based on today’s indoor and outdoor measurements, the sinks and toilets availability, the capacity of 51 preschool children ages 2 to 5 years old in five rooms (room 4 and 5 combined) will be final reviewed and discussed with management in the Regional Office. The facility will be notified if any additional information is required. Exit interview conducted and report was reviewed with the applicant Phong Chau and director, Vickie Nguyen.
End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC809 (FAS) - (06/04)

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