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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371646
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:42:10 AM

Document Has Been Signed on 11/30/2023 11:42 AM - 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: 24CENSUS: 0DATE:
11/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan Estrada, School Readiness Child Dev CoordinatorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) P Rivas conducted an announced case management visit to measure newly constructed outside playground area. LPA met with Susan Estrada, School Readiness Child
Development Coordinator and together toured the outside play ground activity space.

Per applicant the facility will be using the new playground equipment that is directly outside the portable unit. Per documentation viewed the equipment is age appropriate for 2 to 5 year old children.
Per applicant and lic 999 facility sketch the preschool will be using; 1) the playground equipment (that includes slides ). The equipment is cushioned with rubber which is sufficient to absorb falls; 2)the black top from the west gate to the back of the first school buildings, 3) onto the grass area up to the second tree(which is located directly behind the headstart ). The outside activity space measured at 27,764.26 which is sufficient for the requested capacity.There is a fence surrounding the entire school that is over 4 feet high.

LPA received a copy of waiver request for restroom and sink, class schedule, picture of bathrooms and sinks, updated lic 200a which corrected capacity to 24 children ages 3-5 with two sessions M-F 8:00am to 11:00am and 11:30am to 2:30pm., new lic 999 facility sketch for outside playground, Incidental Medical Services procedures (Admissions of medication during the regular school days), Site Supervisor/Preschool teacher Kristen Esaia's Child Development Site Supervisor's certificate which expires 05/01/2028, information regarding Ms. Esaia's health screening.

LPA will submit waiver request, and The facility will be notified if any additional information is required. Exit interview conducted and report was reviewed with the applicant, Susie Estrada.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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