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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370025
Report Date: 10/05/2021
Date Signed: 10/20/2021 09:23:08 AM

Document Has Been Signed on 10/20/2021 09:23 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LOS ALAMITOS CHILD DEVELOPMENT CTR-ROSSMOOR SITEFACILITY NUMBER:
304370025
ADMINISTRATOR:DAGARIN, JEAN-MARIFACILITY TYPE:
850
ADDRESS:3272 SHAKESPEARE DRIVETELEPHONE:
(562) 799-4585
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY: 26TOTAL ENROLLED CHILDREN: 48CENSUS: 26DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Ms.Dagarin, Jean Mari TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an unannounced on site Annual inspection along with Case Management inspection for a Change in capacity with addition of Room # 21 at the Child Development center rooms. LPA met with Facility Administrator Ms. Dagarin, Jean Mari who gave a tour of the two classrooms ( State Preschool room # 21 and 22) located on the site of RossMoor Elementary school under the Los Alamitos unified school district. Facility currently is licensed for 26 preschool age children (3-5 years of age and now is seeking to increase the capacity to 48 by adding room # 21, which is currently serving special aid children and is a District room
Room # 21, shall offer two half day sessions (8.00 am to 11.00 am) Afternoon session from 11.45 am to 3.00 PM, in these room children will be served snacks only and there will be no napping . Room # 22 is a full day sessions 6.30 am to 6,00 PM. Children in these room are served AM/PM snacks along with afternoon lunch, children nap in this room only . All the food is served from School kitchen, delivered to the classroom and is individually packed. Due to COVID 19, LPA observed staff wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines.

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.

Due to current pandemic situation, Parents are encourage to follow CDC and COVID requirements, children are dropped off and picked up at the curb end - designated gates and parents use a Black wheel app with a QR Code to check in the children, upon entrance staff checks the temperature of the child, a visual check in done, parents sign off the children before the child is handed over to the teacher, who walks the child into the classroom. Hand washing activity is completed before the child engages in other classroom activities.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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: LOS ALAMITOS CHILD DEVELOPMENT CTR-ROSSMOOR SITE
FACILITY NUMBER: 304370025
VISIT DATE: 10/05/2021
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During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.
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.
Food is prepared on school cafeteria ; lunch and snacks are provided. Food prep areas were clean and sanitary. 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 water cooler, sports bottle with the child’s name on it. The children's bathrooms are clean and sanitary. Children nap on mats, and bedding is stored individually and is taken home daily to be washed by parents. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility

Staff files were reviewed for staff present during the facility inspection on this date, 4 out of 6 staff files were reviewed. Health screening and immunization's as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for (licensee and assistant) were reviewed and within compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting 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 8/2023.

The Facility Director 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.

Six children's records were reviewed, and there was a separate, complete and current record for each child. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day. (Page-2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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: LOS ALAMITOS CHILD DEVELOPMENT CTR-ROSSMOOR SITE
FACILITY NUMBER: 304370025
VISIT DATE: 10/05/2021
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LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.
Nurse's office is designated as the Isolation area and she is present on the premises.

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 cushioning material artificial grass around the climbing equipment, swings,slides and
other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by drinking fountains and personal personal water bottles with the child’s name on it. 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.

Transfer Request (LIC9182). The Facility Director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov and they 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
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LOS ALAMITOS CHILD DEVELOPMENT CTR-ROSSMOOR SITE
FACILITY NUMBER: 304370025
VISIT DATE: 10/05/2021
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In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.
A TA was provided on today's inspection : Clear the children's bathroom of all the stored items.
Inspection tool was utilized on today's inspection.

Facility has requested to add Room # 21 to their License, increasing their capacity to 48
Indoor Measurements
Room # 21
34.25
28.92
990.51
0.00
990.51
Room # 22
34.25
29.33
1004.55
0.00
1004.55

Total Indoor measurements : 1995'06 Sq Ft divided by 35= 57
Total sinks: 5 X 15= 75 / Total toilets: 4 X15 = 60

Based on Indoor measurements / Sinks and Toilet availability , Center has sufficient space to accommodate 48 children (3-5 years ) in two assigned room # 21 and 22. Facility does have a Waiver to share the outdoor ward with Kindergarten children with a staggered schedule in place.
Fire clearance has been granted by Orange County Fire Authority for 48 children in the two assigned rooms.

An Inspection and exit interview was completed with Facility Director The report was reviewed and discussed. 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. If the facility receives a Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00
The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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