304270967-2-13-2023-06-CC-DVSA-CNZT7S-20230213132912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270967
Report Date: 02/13/2023
Date Signed: 02/13/2023 01:29:22 PM

Document Has Been Signed on 02/13/2023 01:29 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:	KATHERINE IRVINE DAY SCHOOL		FACILITY NUMBER:	304270967
ADMINISTRATOR:	ROSA DOMINGUEZ		FACILITY TYPE:	850
ADDRESS:	1002 WEST 2ND STREET		TELEPHONE:	(714) 541-8164
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92701
CAPACITY: 64	TOTAL ENROLLED CHILDREN: 64	CENSUS: 33	DATE:	02/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	DIrector, Rosa Dominguez		TIME COMPLETED:	01:45 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 02/13/2023 Licensing Program Analysts (LPAs), Dianna Valdez and Archibaldo Silva conducted an on site visit for the purpose of a 1 year required inspection. LPAs and director toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 8 preschool staff and 33 preschool children. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are Monday through Friday 7:30 AM - 5:30 PM. Entrance checklist (LIC 125) provided to the director. A review of the Facility Personnel Report Summary conducted on 02/10/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. The facility utilizes a food vendor that provides breakfast, lunch and snacks. Food is properly stored. Menus were posted where they could be reviewed by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by filtered water pitchers and disposable drinking cups. Page 1 of 5

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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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Document Has Been Signed on 02/13/2023 01:29 PM - It Cannot Be Edited

Created By: Dianna ValdezSantana On 02/13/2023 at 12:31 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KATHERINE IRVINE DAY SCHOOL	FACILITY NUMBER: 304270967
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation of the Director stating the facility has not conducted lead testing as specified in WD 101700 PIN 21-21.1-CCP, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/13/2023
	Plan of Correction
1 2 3 4	Facility is in the process of testing. Director Rosa Dominguez will put a work order so the proper vendor can test the facility for lead within the next 30 days. Director Rosa Dominguez will email copies of the testing/results before 3/13/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Thuy Ho

LICENSING EVALUATOR NAME:

Dianna ValdezSantana

LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: KATHERINE IRVINE DAY SCHOOL	FACILITY NUMBER: 304270967
	VISIT DATE: 02/13/2023

NARRATIVE

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The children's bathrooms are clean and sanitary. Children nap on mats, and bedding is stored individually and is laundered by the facility daily. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector and fire extinguishers. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material was rubber flooring was around the climbing slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by water coolers and disposable cups. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.

Staff files were reviewed for staff present during the facility inspection on this date, 05 out of 09 staff files were reviewed. Health screening and immunization's as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 states, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for the staff were reviewed and within compliance. There was a statement declining the flu vaccine. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed child care providers, administrators, or employees of a licensed child day care facility to complete the mandated reporter training, and to renew the training every two years.. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 03/23/2024.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: KATHERINE IRVINE DAY SCHOOL	FACILITY NUMBER: 304270967
	VISIT DATE: 02/13/2023

NARRATIVE

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The director was informed that Licensing Quarterly Updates are available at www.cdss.ca.gov/inforesources/community-care-licensing
The 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 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 A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2022/CCP/PIN-22-06-CCP.pdfFacility Director does have lead training Certificate.

Safe Sleep Consultation provided with the director during today's visit. .
LPA discussed the safe sleep regulations with the 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. LPA also informed the director of the 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.

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: KATHERINE IRVINE DAY SCHOOL	FACILITY NUMBER: 304270967
	VISIT DATE: 02/13/2023

NARRATIVE

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Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

LPA, Valdez Santana was available to answer any questions about Safe Sleep that was discussed today. the director stated that she has no questions during today’s consultation.

Director was informed of the Child Care licensing webinars and to review
PIN 22-30-CCP for more information on how to access the Webinars on
On March 28. 2023 at 6:00 PM

Resources: https://ccld.childcarevideos.org/family-child-care-providers/

Staff interview conducted with the director during today’s inspection.

In the areas evaluated, the following violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101700 (b) of the written directives PIN 21-21.1-ccp , is being cited on the attached LIC 809D. The facility representative, Rosa Dominguez stated the facility failed to test their water for lead before the January 1, 2023 per the Written Directive in PIN 21-21.1-CCP.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: KATHERINE IRVINE DAY SCHOOL	FACILITY NUMBER: 304270967
	VISIT DATE: 02/13/2023

NARRATIVE

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Exit interview conducted and report was reviewed with the director, Rosa Dominguez Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

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