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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371501
Report Date: 07/09/2021
Date Signed: 07/09/2021 01:29:51 PM

Document Has Been Signed on 07/09/2021 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:MESA VERDE PRESCHOOL & INFANT CENTERFACILITY NUMBER:
304371501
ADMINISTRATOR:GUERRERO, CHRISTINAFACILITY TYPE:
850
ADDRESS:3013 DEODAR AVENUETELEPHONE:
(714) 513-1686
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY: 42TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/09/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Ms. Guerrero Christina TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a Change of Ownership
LPA met with Facility Director Ms. Guerrero Christina, who gave a tour of the Child Care Center. The applicant has requested to provide care and supervision for 10, Toddlers (18 months - 36 months) and 32 Pre-school age children 2 to 5 years of age, Monday through Friday 6.30 am. to 6.00 PM. in the assigned three classrooms. Due to COVID 19 guidelines, LPA observed facility is following CDC and Dept of Public Health Guidelines. Parents are encouraged to stay in the office area while the staff check the temperatures, hands are sanitized before they are taken to their classrooms. Required postings and COVID posters are posted in the lobby area.

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 is located in a small by lane with a parking lot in front of the Preschool for the staff and parents for drop off and pick ups. There is metal door with a lock in front of the office gate. The front lobby is the designated Director's office and children are received here by staff and lead into the classrooms. The three assigned classrooms are surrounding the office area. There is also a kitchen area and a storage room with staff restroom besides the Director's office. Parents sign them in at the front lobby manually.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 (Page-1)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2021
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 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: MESA VERDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 304371501
VISIT DATE: 07/09/2021
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Medication will be stored in Kitchen cabinet in a locked clear box and shall be administered by the teacher or the Facility in charge, emergency First Aid kits are stored in the classrooms and in the in assigned cabinets. Medication administration forms were reviewed.
Isolation area is the Director’s office and the sick child shall use the restroom located in the Hallway besides the Toddler classroom, there is also an adult restroom in the storage room if needed.

The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through water pitchers with disposable cups
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements.
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Cots are used and are stored at the end of the classroom, napping linens and blankets are provided by the parents.
· Facility provides two snacks and Hot lunches, which are prepared on the premises in the kitchen area, children have the option to bring lunch from home and lunch bags are stored in the Hallway refrigerator and warmed up in the kitchen if needed. The designated Kitchen area has sufficient storage cabinets where snacks are stored and prepared, taken to the classrooms. Kitchen was observed to be free of vermicides and was observed to be clean.

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review) / Child Car Seat Law (PUB 269)
· COVID Posters. (Page-2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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: MESA VERDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 304371501
VISIT DATE: 07/09/2021
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Indoor Measurements: Toddler room : 19'17 x 17'92 = 343'53
Indoor Toddler room : 343'53 divided by 35 = 9'81 (10 ) Toddlers

(Toddler designated toilet is outside the classroom with a changing station also and the sink is within the arm's reach.) It has two sinks and two toilets. (Toddlers shall use the outdoor Infant yard during Lunch time only)

Preschool has two designated rooms : Preschool Room # 1 and Pre-K -Room # 2
Indoor measurements:
Preschool Room # 1 (small area) : 23'5 X 6.92 = 162'62
Preschool Room # 1(Big area) 40'58 X 14'33= 581'51
Pre- K Room #2 21'25 X 17'92 = 380'80

Total Indoor space for Preschool : 1124'93 Divided by 35= 32'14 (32 children)
There are total three toilets (45) and three sinks (45) for preschool age children . Toilets and sinks were observed to be age appropriate. Bathrooms were clean and accessible to children. The facility has communal toilets and sinks in-between Preschool classrooms

Preschool yard: Outdoor measurements : 72'08 X 54.75 = 3946' 38
Total outdoor yard space: 3946'38 divided by 75 = 52'62 (53 children)

The outdoor yard shall be accessed from each classroom . Yard shall be used by the Preschool children and Toddler with a Staggered schedule. There are age appropriate outdoor structures for the desired ages.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water pitchers with small disposable cups
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys,
· An adequate amount of cushioning material consisting of sand is in place under the play structures
· Adequate shade is provided by a Huge tree and shaded patio and benches are placed in this area. (page-3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
Page: 3 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: MESA VERDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 304371501
VISIT DATE: 07/09/2021
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Based on the indoor and outdoor measurements, sink and toilet availability, facility has sufficient space to accommodate the requested capacity of 10 Toddlers (18 months to 36 months and 32 Preschool children ( 2-5 years old) in the assigned two Preschool rooms and one Toddler classroom.

Fire clearance received from Costa Mesa Fire Department approving the the requested capacity of 50 children in the facility (Preschool with Toddler component and Infant program)

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through 10/14/2022 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component) . Facility has also completed the required Water analysis test and the report is on file.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: 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 . Facility Director has complete access to the new Guardian program and all the staff have been associated.

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 applicant/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 (Page-4)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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: MESA VERDE PRESCHOOL & INFANT CENTER
FACILITY NUMBER: 304371501
VISIT DATE: 07/09/2021
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Facility Director will request a Waiver for Staggered schedule in-between the Preschool and the Toddler option class.

The facility was following Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has sufficient activity space as requested to support the capacity of 10 Toddlers in assigned Toddler room and 32 Preschool children in (Preschool Room # 1,& Room # 2 PreK )

A license will be issued for the capacity of 10 Toddlers (18- 36 months) in assigned Toddler room and 32 preschool children age 2-5 years old, in assigned Preschool Room # 1 and Pre -K room # 2, after a final review. The applicant will be notified if any additional information is required.

Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the 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

An exit interview was completed.

The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC809 (FAS) - (06/04)
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