304371575-10-14-2022-06-CC-KDEI-CK7P7B-20221014110339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371575
Report Date: 10/14/2022
Date Signed: 10/14/2022 11:03:55 AM

Document Has Been Signed on 10/14/2022 11:03 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:	JAMES A. WHITAKER PRESCHOOL		FACILITY NUMBER:	304371575
ADMINISTRATOR:	WILLIAMSON, STEPHANIE		FACILITY TYPE:	850
ADDRESS:	8401 MONTANA AVENUE		TELEPHONE:	(714) 521-9770
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 4	DATE:	10/14/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Early Education Director Ms Mary Beckelheimer		TIME COMPLETED:	11:15 AM

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) Desai, Ketki conducted an announced Pre-Licensing inspection at the above facility. This is a State Preschool Classroom following the Title V regulation also. The State preschool classroom is Room # K 1 in Building B on the premises of James A Whitaker Elementary school. LPA met with the Director for Early Education: Ms Beckelheimer, Mary who gave a tour of the one assigned preschool classroom. The applicant has requested to provide care and supervision for 24 Pre-school age children 2 to 5 years of age, Monday through Friday 7:30 AM. to 4:30 PM in one assigned classroom. (Room # K 1). It will be two half day sessions. (AM session: 7.45 to 10.45 am & PM session: 11.45 to 2:45 pm ) 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. 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 on the premises of James A Whitaker Elementary school under Buena Park School District. Parents shall enter through the fenced gate adjoining the preschool yard, across the classroom. Staff member shall receive them at the entrance , a sign in table has been set up outside the classroom and staff shall guide the children to the assigned classroom. Parents sign in electronically at the entrance and Manual sign in sheet is also present if needed. Upon arrival each child has an health evaluation along with hand washing before they participate in the activities. Isolation area is the Nurse's health office in the school office building and nurse office has additional cots with linens for the sick child. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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: JAMES A. WHITAKER PRESCHOOL	FACILITY NUMBER: 304371575
	VISIT DATE: 10/14/2022

NARRATIVE

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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: Room # K 1 in Building B.
· Classroom is adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through personalized water bottles and water fountain in the classroom
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Electronic sign in and out)
· Facility has mounted smoke detector & carbon monoxide detector on the ceiling of the classroom, along with one fire extinguisher mounted on the side wall of the classroom, meeting the statutory requirements.
· Cubbies available for storage of individual child’s personal belongings
· Napping: There is no napping in these program. Facility does have additional mats with linens and blankets on site if needed.
· Facility shall provide Breakfast to children in AM session and Lunch is served to children attending PM session. Food is delivered by the District Nutrition services to the program on site.
Rooms are well lighted with proper ventilation
Room # K 1 has age appropriate activity items and space to move around.
There are three sinks/ 1 toilet and changing table inside the classroom, while additional sinks and toilets are outside the classroom which are shared with the Kindergarten classroom.
There are additional sinks and toilets outside the classroom
Medications are stored in the locked closet and First Aid kit is present in the classroom.
Preschool yard is also outside the classroom.
Children are received at the entrance gate, adjoining the school parking lot, next to the classroom.
(2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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: JAMES A. WHITAKER PRESCHOOL	FACILITY NUMBER: 304371575
	VISIT DATE: 10/14/2022

NARRATIVE

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LPA measured the Preschool Room # K 1 in Building B

Indoor activity space : 1055'68 divided by 35= 30'16 (30 children)
Facility has sufficient indoor activity space to accommodate the requested capacity of 24 children in the one assigned rooms

Total sinks : 5 X 15= 75 children / Total Toilets: 5 X 15=75 children (One toilet inside the classroom and additional toilets outside the room which will be shared and one Toilet and one sink has been designated for Preschool age children)

Facility has age appropriate sinks and toilets inside and outside the classroom.

Preschool outdoor play yard : Facility has designated Preschool yard outside preschool room and following was observed:

· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by personal water bottles and water fountain
· 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: soft cushion
· Adequate shade is provided by shaded structure and roof line shade.
· There is also a bike trail area and a cemented open area for children to play. Children shall access the play yard from exit door opening into the yard.
The play structure is safe for the age group to be served (2-5 years old)
There is additional shaded lunch area set up for outdoor lunch activity.
Play yard is on James A Whitaker Elementary school campus and yard shall be shared with the Kindergarten children. School Principal has given the permission letter to utilize the play yard and restrooms.

Outdoor measurements: 13,056 divided by 75 = 174'08 (174 children)
Based on the indoor /outdoor measurements, sink and toilet availability, facility has sufficient space to accommodate the requested capacity of 24 Preschool age children (2-5 years old) in the assigned Room # K 1 in building B. (3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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: JAMES A. WHITAKER PRESCHOOL	FACILITY NUMBER: 304371575
	VISIT DATE: 10/14/2022

NARRATIVE

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Fire clearance received from Orange County Fire Authority approving the requested capacity of 24 children in the room # K 1 in building B.

Applicant Ms.Beckelheimer Mary is current on the required Immunization/ Pediatric CPR/ First training valid through May 24th 2024 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component and Mandated Child abuse reporting training.

Following items were discussed at the time of Exit interview.
Criminal Record Statement : Applicant, Ms.Beckelheimer, Mary was 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.

Safe Sleep : LPA discussed the safe sleep regulations with applicant Ms. Ms.,Beckelheimer Mary 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 applicant, Ms Beckelheimer., Mary 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.

Incidental Medical Services (IMS) APPLICANT KNOWS FACILITY PLANS TO PROVIDE IMS: This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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 (4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

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: JAMES A. WHITAKER PRESCHOOL	FACILITY NUMBER: 304371575
	VISIT DATE: 10/14/2022

NARRATIVE

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Review of records to be maintained

Child Care Centers :LPA reviewed with applicant, the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant have stated that all records shall be maintained at the School District office and shall be brought to the site at the time of inspection.

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 license-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.

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.

A license for 24 Preschool age children (2-5 years) in classroom # K 1 in Building B.

Monday to Friday : 7.30 am to 4.30 pm
(AM Session: 7: 45 am to 10:45 am & PM Session : 11:45 am to 2: 45 pm)
State preschool following Title 5
Waiver : Shared play yards and restrooms.

Report read and appeal rights presented to the applicant Ms.Beckelheimer, Mary.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022

LIC809 (FAS) - (06/04)

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