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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300602242
Report Date: 07/19/2021
Date Signed: 07/19/2021 03:31:54 PM

Document Has Been Signed on 07/19/2021 03:31 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PAGE SCHOOL OF COSTA MESAFACILITY NUMBER:
300602242
ADMINISTRATOR:DICKSON, KRISTINFACILITY TYPE:
850
ADDRESS:657 VICTORIA STREETTELEPHONE:
(949) 642-0411
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 52TOTAL ENROLLED CHILDREN: 0CENSUS: 28DATE:
07/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Facility Assitant Director Ms. Zaragoza Berenice TIME COMPLETED:
02:43 PM
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A case management Licensee initiated unannounced inspection was conducted on this date by LPA Ketki Desai. The purpose for today’s inspection was to evaluate the facility for a capacity increase as requested by the Licensee. LPA met with Facility Assistant Director Ms. Zaragoza, Berenic, who gave the tour of the new Preschool classroom # 4 and the other 4 Preschool rooms.

Facility is currently licensed for 52 Preschool age children and is seeking to increase capacity to 60 children ages from 2 to 5 years of age, Monday through Friday, 6.30 AM to 6.30 PM.
The program will continue to use the previously assigned rooms (Room # 6,7,8,9 and room # 4 is being added today to the Preschool license.
Room # 4 was a part of Infant program and now being added to Preschool by decreasing the Infant capacity.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, and mat/cot were inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure. An adequate amount of cushioning material is in place under the equipment. Shade is provided by awings covering and a Water pitcher and personnel water bottles are used for drinking water. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, and criminal records clearances/exemption transfer requests.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PAGE SCHOOL OF COSTA MESA
FACILITY NUMBER: 300602242
VISIT DATE: 07/19/2021
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Indoor measurements
Preschool (Room # 4) New
23.17
16.83
389.95
30.20
359.75
Preschool # 6
27.17
14.42
391.79
391.79
Preschool # 7
27.17
14.17
385.00
0.00
385.00
Preschool # 8
27.17
14.17
385.00
0.00
385.00
Preschool #9
27.17
14.42
391.79
0.00
391.79

Total indoor capacity: 1913.33 divided by 35 = 54’67 (55 children)
The new added Room # 4 has one sink and one toilet for the children.

Total sinks= 13x15= 195
Total toilets = 11 x15=165

Outdoor: Facility has enough outdoor space for 55 children. There are three yards for preschool with age appropriate outdoor climbing structures and additional toys. The fencing is safe with grass flooring.

Total outdoor space is approximately 7200 square feet that accommodate the total capacity for preschool program.

Fire clearance from City Of Costa Mesa Fire prevention office has been received on 7/13/21 and approved for 96 children, total including infants/ toddler.

Based on today’s indoor measurements of the new classroom, capacity can be approved only for 55 children instead of 60 children as requested. Earlier Fire clearance report have indicated only 8 children in the new room # 4.

Licensing report was reviewed with the director. The director was informed that capacity is limited to 55 children due to indoor activity space. Page-2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PAGE SCHOOL OF COSTA MESA
FACILITY NUMBER: 300602242
VISIT DATE: 07/19/2021
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Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

After a tour of the center, no deficiency was observed. File will be submitted for approval as of today.

Exit interview conducted. Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
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