304371621-5-1-2023-06-CC-MMAK-CREV9Q-20230501161441

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371621
Report Date: 05/01/2023
Date Signed: 05/01/2023 04:14:48 PM

Document Has Been Signed on 05/01/2023 04:14 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	TRF CORBIN		FACILITY NUMBER:	304371621
ADMINISTRATOR:	MEJICO, DANETTE		FACILITY TYPE:	840
ADDRESS:	2215 WEST MCFADDEN AVENUE		TELEPHONE:	(310) 420-1025
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 32	CENSUS: 0	DATE:	05/01/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Applicant and director		TIME COMPLETED:	04:45 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	Page 1 of 4 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced on site pre-licensing inspection at this childcare center for the purpose of operating a school age program. LPA met with the Applicant, Renee Jacobs and director, Danette Mejico. LPA was given a tour by the applicant and director of the school classroom and outdoor space. This school age program is located at Corbin Community Center. The applicant has requested to provide care and supervision for 32 school age children ages 5 to 12 years old, Monday to Friday from 1:00 pm to 6:00 pm. and 7:00 am to 6:00 pm on full days such as Spring Break, Winter Break, and Summer Break. The facility runs Title 5 Program. LPA observed the facility 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. Parents sign in and out their children manually. The applicant stated they will switch to Bright wheel application in the future for signing in and out by parents. Staff will pick up the children from Monte Vista Elementary School across the street and walk them to this site during school days. The staff sign the children in and parents will sign them out during school days. Upon arrival each child has an health evaluation along with hand washing before they participate in the activities. Continued on age 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TRF CORBIN	FACILITY NUMBER: 304371621
	VISIT DATE: 05/01/2023

NARRATIVE

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LPA measured the classroom and the measurement is as below:
One large school age room is approximately 1225 square feet divided by 35 = 35 children.
Total sinks: 3 X 15= 45 children.
Total toilets: 5 X 15=75 children.
One urinal in the boys' bathroom.
There are 3 toilet, one sink in the Girls' Bathroom and there are 2 toilets, one sink, and one urinal in the Boys' Bathroom. The director was reminded that children shall be escorted by a staff person to and from the restrooms.
Outdoor space measurement:
Outdoor activity space is 5589 square feet divided by 75 = 74.52 (75 children)
The following was observed for outdoor space:
The outdoor space is fully enclosed by appropriate fencing at least 4 feet high. There are 3 gates on this courtyard of the facility leading to parking lot. The gates are equipped with pad locks and chains. According to applicant and director the gates on the outdoor space are always locked and they are not used for coming and going. There is one additional gate which is the entrance for staff, children, and parents. The director stated the staff keep the entrance gate locked when they walk the children in from Elementary School. The director stated she will have a staff stationed at the entrance to monitor the coming and leaving activities. Additional alarm device was advised to the applicant and director on the entrance. They stated they have to get the permission from the City since the City owns the building for the future. LPA discussed the supervision and staff stationing on the outdoor space to watch out for the exit gate on the outdoor space. This outdoor space is not shared with any other programs. Outdoor activity space is supplied with age and size appropriate equipment such as games, hop scotch, and play balls. The staff will bring the toys in and out as needed. There are no climbing structure on the outdoor space. The flooring is concrete.
Shade is provided by trees. Drinking water is provided by igloo and Dixie cups for outdoor.
Fire clearance received from Orange County Fire Authority approving the requested capacity of 32 school age children The total measurements of the school age room accommodates the requested capacity.
The director, Danette Mejico is current on the required Immunization/ Pediatric CPR/ First training, the Preventive Health training (Nutrition and Lead component) and Mandated Child abuse reporting training certificate.
Continued on page 4

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TRF CORBIN	FACILITY NUMBER: 304371621
	VISIT DATE: 05/01/2023

NARRATIVE

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Isolation area is the office, located at the corner of the entrance of the classroom. There is an additional mat/cot is available with bedding for the sick child in the Director's office. The bathroom for sick children is the staff bathroom. There is one sink in the director's office ,

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)
· 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 was observed in the classroom. (There is only one large school age room).

· Classrooms are adequately equipped with age and size appropriate furniture and equipment.
There are 3 exit doors in this classroom which are equipped with alarm devices.
· Drinking water is available inside through the water dispenser and Dixie cups.
· Sign in/Sign out procedure was reviewed.
· Facility has in-built smoke detectors & carbon monoxide detectors on the ceiling. There is fire extinguisher mounted that meets statutory requirements.
· Cubbies available for storage of individual child’s personal belongings in the school age room.
· Facility provides afternoon snacks to children during school days, and provides lunches, breakfasts and snacks during full days.
Room is well lighted with proper ventilation.
Medications are stored in the locked box in the office if any.
First Aid kit and Emergency kit is present.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TRF CORBIN	FACILITY NUMBER: 304371621
	VISIT DATE: 05/01/2023

NARRATIVE

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Following items were discussed with director, Danette Mejico at the time of Exit interview.

Criminal Record Statement :The Director, Danette Mejico 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.
Incidental Medical Services Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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
LPA reviewed the LIC 311A, Records to Be Maintained at the Facility for child’s records, personnel records, administrative records, and documents to be posted.

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 will be issued for a total of 32 school age children ages 5 to 13 years old in one room, Monday to Friday from 1:00 to 6:00 pm during school days and 7:00 am to 6:00 pm during Summer, Spring and Winter Breaks after final review and management approval. Exit interview conducted and report was reviewed with the director, Danette Mejico. End of reports

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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