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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371587
Report Date: 09/26/2022
Date Signed: 09/26/2022 02:14:04 PM

Document Has Been Signed on 09/26/2022 02:14 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:BREA HEAD STARTFACILITY NUMBER:
304371587
ADMINISTRATOR:DIAZ, LISAFACILITY TYPE:
850
ADDRESS:480 NORTH STATE COLLEGE BLVD.TELEPHONE:
(714) 241-8920
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
09/26/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Applicant/ Licensee Ms. Padilla, Valerie, Administrator Ms. Diaz, Lisa & Education Manager Ms. Lopez, Alma TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Ketki Desai conducted an on site pre licensing inspection at this proposed new Preschool program.
LPA met with Applicant/ Licensee Ms. Padilla, Valerie, Administrator Ms. Diaz, Lisa & Education Manager Ms. Lopez, Alma and toured the new Infant room.
The applicant has requested to provide care and supervision for Preschool age children, 2 to 5 years in the designated three classrooms (Room # 1,2 and 3), Monday through Friday, 7:30 am. to 5:30 pm.
The facility is on the Church complex (Brea United Methodist Church)

Facility is a Head Start program and follows Title 22 .

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 parents and children shall enter through the fencing gate across the parking lot of the facility and shall sign at the classroom entrance, manually. Facility has COVID Guidelines and posters posted in the facility.

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 (1)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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: BREA HEAD START
FACILITY NUMBER: 304371587
VISIT DATE: 09/26/2022
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Granted Waivers (available for review)
· Child Car Seat Law (PUB 269) / · Sudden Infant Death Syndrome Poster
· Shaken Baby Syndrome Poster

The three new classrooms were measured on today's inspection> Classroom 1, 2 and 3
· Each Classrooms are adequately equipped with age and size appropriate furniture, toys and equipment
· Drinking water is available inside by water pitchers and personal water bottles
· Sign in/Sign out procedure was reviewed and meets regulation requirements (Manual sign in and out)
· There are working smoke detectors, carbon monoxide detectors, fire alarms and fire extinguishers mounted in each rooms that meet statutory requirements
· Cubbies available for storage for individual child’s personal belongings and/or bedding
· The changing table is within arm’s reach of a sink in Room # 2 and 3
· The changing table has padding with raised sides
· There are sinks and attached baby toilets adjoining the classrooms
This is a full day program, Breakfast/ Lunch and PM snack shall be provided by the facility which shall be delivered from the main facility kitchen (Placentia Kitchen)
Each room has their own entrance adjoining the designated room office.
Children shall nap on Blue cots, linens and blankets are provided by the facility, bedding and linens are washed on premises.
Center policy: Facility shall provide all the needed items for the preschool age children, including pull-ups, wipes for ages 2 and 3. Director's office is the Isolation area for sick child and additional linens are available.

All the three rooms were measured today with following measurements :

Total indoor activity area : 1887'24 divided by 35 = 53'92 (54 children).

Facility has sufficient space to accommodate 40 preschool age children in the three assigned rooms as requested on the application.

Facility Director Ms. Diaz, Lisa is current on the required Pediatric CPR/First Aid training valid upto 4/18/2024 (2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
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: BREA HEAD START
FACILITY NUMBER: 304371587
VISIT DATE: 09/26/2022
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Total children toilets and sinks: There are toilets with sinks inside the classrooms.
Sink : 8 X 15= 120 / Toilets: 5 x 15= 75

The following were inspected in the outdoor activity space; The preschool yard is across the office area and children shall walk through a small passage to access the play yard.
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water pitchers and personal water bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures , labeled for 2- 5 years of age
· An adequate amount of cushioning material consisting of soft cushion material placed under the play structures
· Adequate shade is provided by roof top canopy
There is a shaded area with benches which shall be used for additional activities.
There is bike trail surrounding the play yard.
The yard has two additional fenced metal gates with appropriate locks, it cannot be reached by a preschool child.
There is storage shed in the play yard with locks installed on it.

Total outdoor activity space was measure and is as follows:

Total outdoor activity area :4782'12 divided by 75= 63'76 (64 children)
Based on Indoor / Outdoor / Sinks and Toilet availability facility has sufficient space to accommodate the requested capacity for 40 preschool age children in the assigned rooms.

The facility was in compliance with Title 22 requirements at the time of the inspection.

Fire clearance has been approved by Brea Fire department for total capacity of 40 Preschool age children in room #1,2 and 3.

A license will be issued for the capacity of 40 preschool age children (2-5 years) shall be issued after a final review. Monday to Friday: 7:30 to 5:30 pm. Applicant shall be notified if additional information is needed. (3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
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: BREA HEAD START
FACILITY NUMBER: 304371587
VISIT DATE: 09/26/2022
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LPA discussed the following the facility Director Ms. Diaz, Lisa during the Exit interview
Criminal Record Statement : Facility Director Ms. Diaz, Lisa 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 Facility Director Ms. Diaz, Lisa and also 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 Facility Director Ms. Diaz, Lisa 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 : 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

Exit Interview

Exit interview conducted and report was reviewed with the Facility Applicant/ Licensee Ms. Padilla, Valerie, Administrator Ms. Diaz, Lisa & Ms. Lopez, Alma

Review of records to be maintained

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

(4)

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

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
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: BREA HEAD START
FACILITY NUMBER: 304371587
VISIT DATE: 09/26/2022
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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.

Exit interview concluded , Appeal Rights were presented to the Facility Applicant/ Licensee Ms. Padilla, Valerie.

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

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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