304371705-10-3-2024-06-CC-PRIS-D9PQW5-20241003123121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371705
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:32:50 PM

Document Has Been Signed on 10/03/2024 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	BOYS AND GIRLS CLUBS - CLINTON CORNER		FACILITY NUMBER:	304371705
ADMINISTRATOR/ DIRECTOR:	SHANICE WHITE		FACILITY TYPE:	860
ADDRESS:	13581 CLINTON STREET		TELEPHONE:	(714) 719-6190
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 5	DATE:	10/03/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:07 AM
MET WITH:	Yumi Ramirez, Administrative Director		TIME VISIT/ INSPECTION 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	On 10/03/2024 at 10:00am, Licensing Program Analyst (LPA), P Rivas conducted an announced Pre-Licensing inspection for a new single license which will be consolidated with current infant license 304371494. The facility is located on Clinton Corner Family Campus. Upon arrival, LPA met with Applicant/Facility Representative Ms. Yumi Ramirez and Site Supervisor, Shanice White. Applicant is requesting to be licensed for 24 toddler option children only in Rooms 18 & 20 which are next door to each other.Hours of operation will be 7:00am to 6:00pm Monday through Friday. This facility is state and federally funded HeadStart Program. Facility has a Waiver allowing for Administrative file for criminal record clearances to be processed through Family Campus #304270647, All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Ramirez that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Ms. Ramirez stated that they will be in the classroom. A fully equipped first aid kit is in located in each room. There is an operational carbon monoxide detector on site located on wall in each room. All required licensing documents were observed posted in the front area where children are signed in and out. Children will be signed in and out at entrance. Facility is using CARE Connect but can print out documents for LPAs use and will use paper copy if system is inoperable. LPA continued to tour the facility and measured all indoor and outdoor activity space. Total indoor activity space measured at 1866.4 square feet, which is sufficient to accommodate the requested capacity of 24 Children. LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots/mats bookshelves, and other

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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: BOYS AND GIRLS CLUBS - CLINTON CORNER	FACILITY NUMBER: 304371705
	VISIT DATE: 10/03/2024

NARRATIVE

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activity supplies for the children. Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via water jugs with cups. Jugs are filled on campus. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 07/16/2024.

Chairs have broad-based legs, plastic seats are in good repair Changing table are padded with raised sides, washable material. Sides of the changing table are at least 3” high and the changing table is within arm’s reach of a sink. Diapering sink is not used for meal preparation or dishwashing. Sleep logs are kept in a binder in each room. Needs and Services Plans are kept in child's file. Linens will be provided by facility and washed by facility.

LPA observed a total of 4 sinks available for children’s use. These are sufficient to accommodate the requested capacity of 24 children. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the staff lounge and bathroom is also in staff lounge.

Facility will provide breakfast, lunch, and PM snack. Food will be delivered by a vendor. LPA advised that the licensee is ultimately responsible to provide adequate, nourishing food.

The facility currently has a fully fenced playground area which is separate from other components. Fencing is chain link fence and is at least four feet high. The total square footage for all the outdoor activity space is 3984 square feet, which is sufficient to accommodate the requested capacity. Shade is provided via large USA Shade and two portable umbrellas. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There was no climbing structure on the playground for children. Drinking water is available via water jug that is filled by faucet. LPA observed all hazardous items on the playground to be inaccessible to children. Ms.Ramirez was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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: BOYS AND GIRLS CLUBS - CLINTON CORNER	FACILITY NUMBER: 304371705
	VISIT DATE: 10/03/2024

NARRATIVE

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For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).
Facility water was tested March 2023 under license#304371494.

The following items are needed prior to issuance of the license;
1. Control of Property(needs to reflect the 24 children in care)
2. Ms. Ramirez and Ms.Sepulveda's' fingerprint clearances
3. Ms. Ramirez' and Ms. White's updated mandated reporter training
4. Ms. Ramirez' and Ms. White's updated first and and cpr.
5. Final Review

Applicant was also advised, once licensed, under new single license, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file

An exit interview was completed. The report was reviewed and discussed. Ms. Yumi understands that proof of corrections must be provided to the Department within 30 days or the application may be denied.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC809 (FAS) - (06/04)

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