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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371504
Report Date: 02/02/2022
Date Signed: 02/02/2022 02:45:57 PM

Document Has Been Signed on 02/02/2022 02:45 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:KIDDIE ACADEMY OF COSTA MESAFACILITY NUMBER:
304371504
ADMINISTRATOR:HAIKAL, JOSEPHFACILITY TYPE:
850
ADDRESS:1815 ANAHEIM AVENUETELEPHONE:
(949) 402-3288
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 94TOTAL ENROLLED CHILDREN: 94CENSUS: 0DATE:
02/02/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Applicant Ms. Scarlet, Amy & Facility Administrator Ms. Trenner, TinaTIME COMPLETED:
12:30 PM
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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 New center. LPA met with the new incoming Director Ms. Trenner, Tina & Ms. Scarlet, Amy who gave a tour of the Child Care Center.

The applicant has requested to provide care and supervision for 94 Pre-school age children 2 to 5 years of age, Monday through Friday 6:30 AM. to 6.30 PM. in the assigned four classrooms.

LPA observed staff following CDC and Dept of Public Health Guidelines. Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements, children shall be received at the entrance door by the staff, temperatures shall be checked, hands sanitized before they are taken to their classrooms. Parents sign them in at the front lobby electronically.

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 a new construction, with parking area for parents in front of the main entrance of the center upon entering the facility through the glass door, there is a front lobby area, where facility staff is available to respond to any queries by the parents or visitors. There is a computer set up for electronic sign in out for the enrolled children . The four assigned classrooms are within the same level. Director's office/ Staff lounge with adult bathrooms, kitchen are located adjoining the classrooms .

Facility also has an infant / toddler program with two separate classrooms.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
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: KIDDIE ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371504
VISIT DATE: 02/02/2022
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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

Medication will be stored in the Director's office in a locked cabinet 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.

First Kit was checked and has the needed items including scissors/ tweezers.

Isolation area is the Director’s office and the sick child shall use the restroom located next to the lobby area there is an additional cots with linens for the sick child.

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.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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: KIDDIE ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371504
VISIT DATE: 02/02/2022
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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 personalized water bottles and water fountain, which were observed in each preschool rooms, it has a step stool for the child to reach if needed.
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Electronic 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 also has additional linens if needed.
· Facility provides AM/PM snacks along with lunch, which is prepared in the kitchen area. The food is only heated or mixed, it is taken to each classroom by the staff member. The food is served in the family style for older preschoolers and young preschoolers the dish is prepared by the staff. Food is served in safe utensils which are washed in the Dishwasher located in the kitchen area.
Kitchen area is free of pests or vermicides.
Facility has a service with Pest control company. Cleaning supplies/ Pesticides are stored in the Janitor's closet which remains locked and inaccessible to children.

LPA measured the four Preschool rooms

Room Identification Length Width Area Encumbered Space
Two's Preschool
39.17
21.83
855.08
855.08
Three's Preschool
37.83
36.17
1368.31
80.20
1288.11
Four's Preschool
23.75
18.08
429.40
429.40
18.58
13.08
243.03
0.00
243.03
14.42
10.5
151.41
0.00
151.41
Five's Preschool
24
14.58
349.92
0.00
349.92
9.25
7.67
70.95
70.95

Total indoor capacity : 3387'90 divided by 35 = 96'80 ( 97 children) (Page-3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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: KIDDIE ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371504
VISIT DATE: 02/02/2022
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Facility has requested 94 preschool age children.

Total sinks : 10 X 15= 150 children
Total Toilets: 8 X 15= 120 children

Facility has age appropriate sinks and toilets in the classrooms. Toilets are built inside the rooms with sinks . The Two's room bathroom has a changing table with a sink within arm's reach.

Preschool outdoor play yards : Facility has designated Preschool yards and following was observed:


· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water fountains
· 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 soft cushion is in place under the play structures
· Adequate shade is provided by shaded structure (Canopy)and roof line shade.
· There is also a bike trail area and a cemented open area for children to play.
Preschool room (Two's and Three's ) has direct access to the yard, while the other three rooms shall walk through the hallway to access the yard. The play yards are safe.

Outdoor measurements
Area identification LengthWidth
Area
Encumbered
Space
Preschool big yard
74.67
61.92
4623.57
4623.57
side green water area
20.92
7.25
151.67
151.67
Side yard
37.25
13.92
518.52
518.52
small yard with climbing structure
50.17
31.17
1563.79
1563.79

Total outdoor space: 6857'55 divided by 75= 91'43 ( 91 children) (Page-4)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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: KIDDIE ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371504
VISIT DATE: 02/02/2022
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Based on the indoor and outdoor measurements, sink and toilet availability, facility has enough space to accommodate only 91 Preschool children ( 2-5 years old) in the assigned four classrooms. Limiting factor is the outdoor space. (A waiver shall be requested to accommodate the requested capacity for 94 preschool children)
Fire clearance received from Costa Mesa Fire Authority approving the requested capacity of 114 children
(Includes 8 infants and 12 Toddlers) in the six assigned rooms.

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through March 13th 2023 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component and Mandated Child abuse reporting training.

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

Applicant, Ms. Scarlet, Amy and Facility Administrator Ms. Trenner, Tina were reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA reviewed with the Applicant, Ms. Scarlet, Amy and Facility Administrator Ms. Trenner, Tina LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. (Page-5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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: KIDDIE ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371504
VISIT DATE: 02/02/2022
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Applicant, Ms. Scarlet, Amy and Facility Administrator Ms. Trenner, Tina were reminded to Subscribe to CCLD important information : 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.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. Facility has access to the new system.



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

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 enough activity space to support the capacity for 94 preschool age children. A Waiver for outdoor activity shall be requested to accommodate the requested capacity

A license will be issued for the capacity of 94 preschool children age 2-5 years old, in the four preschool rooms (Two's/ Three's / Four's and Five's) Monday to Friday 6:30AM to 6:30PM after a final review. The applicant will be notified if any additional information is required.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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: KIDDIE ACADEMY OF COSTA MESA
FACILITY NUMBER: 304371504
VISIT DATE: 02/02/2022
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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

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.

Exit interview conducted and report was reviewed with the Applicant, Ms. Scarlet, Amy and Facility Administrator Ms. Trenner, Tina.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
LIC809 (FAS) - (06/04)
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