Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370976
Report Date: 01/23/2019
Date Signed: 01/23/2019 01:01:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CRESCENT HEAD STARTFACILITY NUMBER:
304370976
ADMINISTRATOR:LISA DIAZFACILITY TYPE:
850
ADDRESS:5600 CRESCENT AVENUETELEPHONE:
(714) 241-8920
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:30CENSUS: 20DATE:
01/23/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Director Lisa DiazTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) and director toured the facility inside and outside. LPA observed 20 children playing outside with 7 staff members. LPA inspected the following areas: availability of drinking water, age appropriate sinks and toilets, water temperature, toilet paper, paper towels, medication policy, storage areas for poisons and furniture & equipment, food preparation areas, cleaning and food supply storage areas, outdoor equipment (safety, cushioning material, good repair, and age appropriateness, required shade, drinking water and fencing), play area (hazards and inaccessibility to bodies of water), teacher child ratios (staff names recorded), care and supervision, sign in and out sheets. Proves of required immunization (MMR, TDAP, FLU) and Mandated Reporter Training were available for review. A review of children’s & Staff records were reviewed to identify that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also observed Health Screenings and verification of CPR/First Aid and Preventative Health Practices. Facility has operable carbon monoxide.

Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Any proposed changes to the physical plant, including telephone number, or change of address shall be immediately reported to the Department.

After a tour of the center, review children and staff's records, no deficiency observed.

Exit interview was conducted. The Notice of Site Visit was posted. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. , “The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2019
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CRESCENT HEAD START
FACILITY NUMBER: 304370976
VISIT DATE: 01/23/2019
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The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

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 facility representative was informed, and website given, about the California Child Care Disaster Plan has 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 and a copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2824
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2019
LIC809 (FAS) - (06/04)
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