304371712-12-4-2024-06-CC-PRIS-DBMQG7-20241204110906

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371712
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:11:53 AM

Document Has Been Signed on 12/04/2024 11:11 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:	STANFORD ECP		FACILITY NUMBER:	304371712
ADMINISTRATOR/ DIRECTOR:	PHAM, SARAH		FACILITY TYPE:	860
ADDRESS:	12721 A MAGNOLIA STREET		TELEPHONE:	(714) 530-0430
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	12/04/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:01 AM
MET WITH:	Sarah Pham, Division Director/Designated applicant;Adriana Buelna Site Supervisor		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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 Analysts (LPA) Pat Rivas conducted a scheduled pre licensing inspection for a new license and met with applicant/director Ms. Sarah Pham and Site Supervisor Adriana Buelna, later met by Ms. C Sepulveda, VP Community Impact. Applicant is requesting to be licensed for 24 infants (6 months through 24 months) in Trailers 1 and Trailer 2 which are located on the Stanford Elementary School site. The facility has it's own entrance . Hours of operation will be Monday-Friday 7am to 5:30pm. This is a TITLE 5 SCHOOL & FEE BASED. The Licensee Boys & Girls Club of Garden Grove has a waiver that allows for an administrative facility to which all criminal record background check to be associated which is Family Campus Preschool #304270647. All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Ms. Pham 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. Pham stated they will be kept in the site supervisor's office locked in a cabinet. A first aid kit is located in each room. There is an operational carbon monoxide detector on site located in trailers. All required licensing documents were observed posted in trailer #1 which is located near the front door. Children will be signed in and out at prior to entering the facility via Care Connect. A paper copy can be provided to CCL upon request. If system is non operational, paper copies will be kept.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: STANFORD ECP	FACILITY NUMBER: 304371712
	VISIT DATE: 12/04/2024

NARRATIVE

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LPA continued to tour the facility and measured all indoor and outdoor activity space, Total indoor activity space .measured at 1983.75, square feet which is sufficient to accommodate the requested capacity of 24 infants. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping cots/mats, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms facility will provide filtered water. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water and no weapons on the property. A fire clearance was granted on 12/02/24 for 24 infants ages 6 through 24 months in trailers 1 and 2.

LPA observed a total of 9 sinks and 4 toilets available for children’s use. These are sufficient to accommodate the requested capacity of 24 infants. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the office. The staff bathroom will be used if children are ill. LPA viewed chairs and feeding tables have broad-based legs, wooden seats are in good repair and trays lock onto chairs. Diapering sink is not used for meal preparation or dishwashing. Cribs meet regulatory requirements. Crib area is separated from activity space via a plexi glass partitions . Barrier is at least four feet high, made of sound absorbing material and allows for supervision of napping children. Sleep logs are kept in the infant room . Needs and Services Plans and Sleep Plans are kept in infant room. The kitchen, site supervisor

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: STANFORD ECP	FACILITY NUMBER: 304371712
	VISIT DATE: 12/04/2024

NARRATIVE

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office will be located in Trailer 1. A lactation room, staff room and laundry room will be located in Trailer 2. The facility will launder linens daily.

Facility will provides meals. The kitchen area currently includes (stove, refrigerator,dishwasher and microwave & sink). The kitchen area and food storage areas were observed free of rodents and/or vermin. Food was observed to be properly stored separate from cleaning materials. Hazardous items in kitchen are inaccessible to children via child proof locks. Hot water is available in kitchen.

The facility currently has a fully fenced playground area. Fencing is chain link fence which is at least four feet high. The total square footage for all the outdoor activity space is 5205.81 square feet, which is sufficient to accommodate the requested capacity. Shade is provided via umbrellas, and trees. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is no climbing structure. Drinking water is available via water bottles. LPA observed all hazardous items on the playground to be inaccessible to children. Applicant, Ms. Pham was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

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).

LPA discussed the safe sleep regulations with applicant, Nancy Hanna and 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 applicant, Ms. Pham of the

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: STANFORD ECP	FACILITY NUMBER: 304371712
	VISIT DATE: 12/04/2024

NARRATIVE

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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.”

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 licensed 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 director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The director was informed, and website given, about the California Child Care

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: STANFORD ECP	FACILITY NUMBER: 304371712
	VISIT DATE: 12/04/2024

NARRATIVE

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Disaster Planhas been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org
LPA discussed the safe sleep regulations with director and 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.

Licensee 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.

The following is needed prior to licensure;
1. Provide a changing table. Changing table has to be at least 1” padding covered with moisture-resistant, washable material. Sides of the changing table are at least 3” high and the changing table is within arm’s reach of a sink.
2.Remove KOALA changing tables.
3. obtain Current first aid manual
4. Final review

Items to be submitted by 12/20/24. Pictures and receipts to be sent to LPA Rivas for review.
Applicant/Licensee Representative Pham understands that all 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: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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