<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371532
Report Date: 11/16/2021
Date Signed: 11/16/2021 04:31:47 PM

Document Has Been Signed on 11/16/2021 04:31 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:EVERBROOK ACADEMY LLC DBA PRESTIGE PRESCHOO1 ACADEFACILITY NUMBER:
304371532
ADMINISTRATOR:WELCH, AMBERFACILITY TYPE:
850
ADDRESS:16498 ROYAL OAKTELEPHONE:
(949) 559-6810
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 196TOTAL ENROLLED CHILDREN: 196CENSUS: 57DATE:
11/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Ms. Welch, Amber and District Manager Learning Care group Ms.Keramati, Mariam TIME COMPLETED:
12:00 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
Licensing Program Analyst (LPA) Ms. Desai, Ketki conducted an announced on site pre-licensing inspection at the childcare center. It is a Change of Ownership. Emergency approval is valid through November 24th 2021. LPA met with Facility Director Ms. Welch, Amber and District Manager of Learning Care group Ms. Keramati, Mariam who gave a tour of the Child Care Center.
The applicant has requested to provide care and supervision for 196 Pre-school age children 2 to 6 years of age, Monday through Friday 7:00 am. to 6:.00 PM, in the assigned eight classrooms. Due to COVID 19, LPA observed staff and children 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.

Upon entering the facility through the glass door, there is a front lobby area, where facility staff receive the children, temperatures are checked before they are lead into the classrooms.

Due to COVID pandemic parents are encouraged to follow the CDC and COVID requirements, Parents sign them in at the front lobby electronically as well as 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: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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: EVERBROOK ACADEMY LLC DBA PRESTIGE PRESCHOO1 ACADE
FACILITY NUMBER: 304371532
VISIT DATE: 11/16/2021
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
26
27
28
29
30
31
32
Medication will be stored in each classrooms 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 and forms are placed in their individual boxes & binder also.
Isolation area is located in the front lobby area, there is a small room where the sick child shall be isolated, the child shall use the adult restroom located in the back passage area, there an additional mat and 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.

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 (Electronic & 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 lunch, facility has a designated kitchen area where all the snacks and lunch is prepared and taken to the classrooms. Kitchen was observed to be free of vermicides. There is a designated staff preparing the meals. Younger children are offered additional snacks if requested. (2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC809 (FAS) - (06/04)
Page: 2 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: EVERBROOK ACADEMY LLC DBA PRESTIGE PRESCHOO1 ACADE
FACILITY NUMBER: 304371532
VISIT DATE: 11/16/2021
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
26
27
28
29
30
31
32
Indoor measurements for Preschool 8 rooms
Rooms Length Width Area Encumbered Total
Activity classroom Brook
40.25
21
845.25
0.00
845.25
Preschool: Kinder
37.75
23.75
896.56
0.00
896.56
8.58
9.42
80.82
20.33
60.50
Preschool: Two's
26.33
13.33
350.98
0.00
350.98
18.33
7.17
131.43
0.00
131.43
27.92
10.5
293.16
0.00
293.16
Early Preschool
40.08
22.33
894.99
45.36
849.63
Preschool 1
40.08
20.42
818.43
818.43
Preschool 2
40.08
21.25
851.70
851.70
Pre-K -1
19.83
10.5
208.22
20.33
187.89
29.67
23.5
697.25
697.25
Pre K -2
34.25
20.83
713.43
12
701.43
11.42
11.42
130.42
130.42

Total indoor space : 6,814.61 divided by 35= 194.70 = 195

Total sinks: 18 X 15= 270 (children) / Total Toilets: 17 X 15= 255 (children)


There are sufficient toilets and sinks in the facility

Toilets and sinks were observed to be age appropriate. Bathrooms were clean and accessible to children. The facility has toilets and sinks in each classrooms

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, (Page-3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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: EVERBROOK ACADEMY LLC DBA PRESTIGE PRESCHOO1 ACADE
FACILITY NUMBER: 304371532
VISIT DATE: 11/16/2021
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
26
27
28
29
30
31
32
· An adequate amount of cushioning material consisting of soft cushion is installed under the climbing structure
· Adequate shade is provided by shaded structures (Canopy)
· Facility has installed grass across the play yards.
There are two toilets and one sink in the play yard area for children.

Outdoor measurements :

Preschool yard 1 (Climbing Structure)
76.67
57.17
4383.22
4383.22
Large preschool yard
145
130
18850.00
18850.00
Total outdoor yard : 23,233.22 divided by 75= 309.78 (310) children.

Based on the indoor measurements, facility has enough space to accommodate only 195 Preschool children ( 2-6 years old) in the assigned eight classrooms. Facility requested 196 children. Facility has sufficient outdoor space with required sinks and toilets on the premises to accommodate the requested capacity.



Fire clearance received from Orange County Fire Authority have approved the Total capacity of 240 children that includes (30 Infants/ 196 Preschool and 14 School age children)

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through 8/2022 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component)

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

DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
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: EVERBROOK ACADEMY LLC DBA PRESTIGE PRESCHOO1 ACADE
FACILITY NUMBER: 304371532
VISIT DATE: 11/16/2021
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
26
27
28
29
30
31
32
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
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 of only 195 Preschool children in the eight classrooms ( Kinder /Two's/ Early Preschool /Preschool -1/ Preschool 2/ Pre-K1 /Pre-K 2 and The Village)
A license will be issued for the capacity of 195 preschool children age 2-6 years old, 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: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5