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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371646
Report Date: 11/08/2023
Date Signed: 11/28/2023 12:08:27 PM

Document Has Been Signed on 11/28/2023 12:08 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)FACILITY NUMBER:
304371646
ADMINISTRATOR:ESTRADA, SUSANFACILITY TYPE:
850
ADDRESS:7800 HOLDER STREETTELEPHONE:
(714) 228-3153
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 0DATE:
11/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan Estrada, School Readiness Child Dev CoordinatorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Patricia Rivas conducted an announced on site pre-licensing inspection at this childcare center for the purpose of operating a State Preschool Program at this site. LPA met with the applicant, Child Development/School Readiness Coordinator, Susie Estrada. LPA and applicant toured the facility inside and outside and floor and yard plan were verified. There is one portable unit (C3) which has been designated for preschool children ages 3 to 5 years old. The preschool program is located on the grounds of Raymond Temple Elementary School. All the staff are employees of the Centralia Elementary School District.

The applicant has requested to provide care and supervision for a total of 48 preschool children offering 2 sessions with a total capacity of 24 children per session ages 3-5 years old. The operational hours are from Monday -Friday 8am-11am and 11:30am-2:30pm. This facility runs a half day programs per session.
LPA was advised that children will not be napping in the facility.

Breakfast will be provided for session 1 and lunch provided for session 2. Lunch will be transported to school from Dysinger Elementary school and kept in Kitchen located in the Multi Purpose Room prior to serving food.
Water is provided in the children's water containers with their names on them. The facility refills the water for children if needed from a portable water filtered dispenser (currently vendor is Sparkletts) which are located in teacher's lounge and main office.

Per applicant the facility Portable unit was purchased in Spring of 2023 and does not require Lead testing. Verification of purchase date which was emailed to LPA Rivas on this date.

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SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646
VISIT DATE: 11/08/2023
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Isolation area is the corner side of the classroom for the sick child until the parent picks up the sick child/ren. The restroom will be used for this purpose. A mat with separate beddings is designated for this area away from the other children. Other children will be using next door's restroom.
Parents sign in and out at the entrance of the classroom.

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) and Personal Rights form
· 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 Care Seat Law (PUB 269)

The following was observed in the classroom:
Age appropriate furniture and equipment’s
Toys, tactile equipment. Rooms are well lighted with ventilation.
There is sufficient open area for the children to move.
Storage cubbies are arranged to store personal belongings
Flooring is carpet only.

LPA viewed one sink and one toilet in classroom.

LPA measured Indoor capacity for a total square footage of 900.89 feet, which allows for a total capacity of 25 children.

Fire clearance received from Orange County Fire Authority approving 24 children in the room at one time. Including a maximum of 6 children under 36 months.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646
VISIT DATE: 11/08/2023
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Outdoor activity space is the playground for Kindergarten children of this school site which will be shared with State Preschool children. A waiver request will be sent to our office for this purpose.
Outdoor space for preschool children 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 adequate of cushioning. There is a high play structure on the outdoor activity space for preschool children with slide. There are adequate cushioning made of rubber turf around and under the falling zones. Shade is provided a shade cover.
LPA measurement of the outdoor activity area is 23078.57 square feet which is sufficient for requested capacity
During visit LPA viewed and was advised that construction is being done for facility's own playground area.
LPA observed area to be made inaccessible via a chain link fence. Applicant advised that she was told construction will be completed by 11/15/23.

The Site Supervisor for this site is Kristen Esaia who is current on the required Immunization/Mandated Child abuse reporting training and Health and Safety Training. The Pediatric CPR and Pediatric First aid training certificate expires 01/10/24 which is EMSA approved.

Following items were discussed at the time of Exit interview.
The facility representative, advised that the staff are working under Title 5 and and fingerprinted through the school district.

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. The plan was submitted to LPA during inspection.


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SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRALIA-STATE PRESCHOOL AT (RAYMOND TEMPLE)
FACILITY NUMBER: 304371646
VISIT DATE: 11/08/2023
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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 platforms. Applicant has signed up for PIN notices and will have Site Supervisors sign up as well.

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.

Based on today’s indoor and outdoor measurements, the sinks and toilets availability, the request of the facility for 48 preschool children ages 3 to 5 years old in room C3 is insufficient. However, the square footage for indoor use is sufficient for 25 children and outdoor square footage is sufficient for requested capacity. Applicant advised she will submit a waiver request for sinks and toilets in order to meet capacity .
The following is needed
1- Waiver request for sharing playground and restrooms. Please send waiver request letters including the outdoor scheduling, LIC 999, photo of the playground and restroom.
2- Please provide an updated Health Screening for Site Supervisor, Kristen Esaia.
3- A new lic 200 with updated capacity of 24 based on fire clearance.
4-Incidental Medical Services Plan



The facility will be notified if any additional information is required. Exit interview conducted and report was reviewed with the applicant, Susie Estrada. Please send the following to our office no later than 30 days of today's date.

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SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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