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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600331
Report Date: 03/14/2023
Date Signed: 03/14/2023 12:49:33 PM

Document Has Been Signed on 03/14/2023 12:49 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FULLERTON FIRST UNITED METHODIST PRESCHOOLFACILITY NUMBER:
300600331
ADMINISTRATOR:JIMENEZ, KELLYFACILITY TYPE:
850
ADDRESS:114 NORTH POMONA AVENUETELEPHONE:
(714) 773-1002
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 11DATE:
03/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:DirectorTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of adding Toddler Option in their Preschool Program. LPA met with director, Kelly Jimenez who gave a tour of the school to LPA. Currently the facility is licensed for 40 preschool children ages 2 to 6 years old in 3 rooms. (Green Room, Yellow Room, and Blue Room). LPA observed there were a total of 11 preschool children with 2 staff on the playground.

A review of the Facility Personnel Report Summary on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility has requested to provide care and supervision to 26 preschool children and 14 toddlers ages 18 months to 36 months old, Monday to Friday from 8:00 am to 2:00 pm. The facility runs a part time 4 hour program from 9:00 am to 1:00 pm. Children do not nap in this program.
The children are dropped off and are singed in and out at the entrance door manually. The facility has met all the posting requirements. All the classrooms were measured.

The indoor activity space measurement for the current requested capacity is as follows:
Room 114 (Green Room) is Toddler Option Room: 598.95 square feet divided by 17.11 (17 children).
Room 117 (Blue Room) is Preschool Room: 438.72 square feet
Room 118 (Yellow Room) is Preschool Room: 554.56 square feet
The total indoor space for all the 3 classrooms are: 1592.23 divided by 35 = 45.49
(45 children).
Continued on page 2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FULLERTON FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 300600331
VISIT DATE: 03/14/2023
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Total outdoor activity space measurement is as follows:
Toddler option program and preschool program have their own playground. Both playground are all fenced with appropriate toys and equipment. There are low high slide and climbing structure on the toddler option program located on the carpet. The director was advised to place rubber mats around and under the falling zones of these two equipment. There are exits gates on the playground which are locked and are not operating during school hours.

Outdoor space for the Toddler Option Program is: 1107 square feet divided 75 = 14.76 (15 children)
Outdoor space for the Preschool Program is: 4864 square feet divided 75 = 64.85 (65 children)

Total of toilets: 4 X 15 = 60 children
Total of sinks: 5 X 15 = 75 children

There are 2 toilets and one sink in the Girl's bathroom for usage of toddlers and there are 2 toilet and one sink in the boy's bathroom in the hallway for usage of preschool children.
There is a diaper changing table in room 114 (Green Room) that meets Title 22 Regulations. The diaper changing table is located within the arm's reach of a sink in the classroom in a way the staff are able to supervise the rest of the children while changing diaper for one child. LPA discussed the process of diaper changing, having child's belonging accessible and never leave a child unattended on the changing table.

The classrooms are equipped with carbon monoxide detector. All the classrooms have age appropriate toys and equipment. The director's file was reviewed. Her CPR and 1st aid expires 7/2024.
Incidental Medical Services – IMS. 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)/ (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

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FULLERTON FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 300600331
VISIT DATE: 03/14/2023
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The facility provides morning snack for children. Parents provide lunch for their children. Water is provided to children through filleted water and Dixie cup and children's own water bottles for indoor and outdoor.

Orange county Fire authority has approved the facility for a total of 36 children including 12 toddlers and is on file.

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 platform. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the director, Kelly Jimenez.

Based on today’s measurements, the sinks and toilets availability, the request of the facility for adding toddler option for a total capacity of 36 children (24 preschool children and 12 toddlers from Toddler Option Program) will be final reviewed and discussed with management in the Regional Office after receiving the following. The facility will be notified if any additional information is required.



Please submit the following no later than 30 days of today's date.

1- A check for 25.00 payable to DSS for decreasing the capacity to 36 children.
2- Cover for the sand box in the toddler playground.
3- Cushioning for under and around the following zones of the slide and climbing structure on the toddler playground.
4- Board resolution letter for the applicant.

End of report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC809 (FAS) - (06/04)
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