Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370976
Report Date: 04/28/2015 12:00:00 AM
Date Signed 04/28/2015 11:31:56 AM

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:CRESCENT HEAD STARTFACILITY NUMBER:
304370976
ADMINISTRATOR:GADLIN, TALISHIAFACILITY TYPE:
850
ADDRESS:5600 CRESCENT AVENUETELEPHONE:
(714) 241-8920
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:45CENSUS: 0DATE:
04/28/2015
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Valerie Padilla and Talishia GadlinTIME COMPLETED:
11:30 AM
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A pre-licensing site visit was conducted today by LPA Ho to inspect and measure facility for capacity determination. The proposed program will operate 2 sessions. Morning session is from 8 - 11:30 and afternoon session is from 12:30 - 4pm Monday to Thursday. Applicant is seeking to provide care for 45 preschool children. LPA toured the entire facility indoors & outdoors and the following measurements were taken:
Indoor:
Classroom 1: 29'3" x 9'4" = 273
24 x 10.5 = 250
= 523/35 = 15 children
Classroom 2: 29.3 x 20 585 - 48 (encumber) = 15 children
Classroom 3: 29.3 x 20 585 - 48 (encumber) = 15 children

Total children toilets and sinks:
3 toilets x 15 = 45 children
6 sinks x 15 = 90 children
Outdoor:
Total outdoor activity space: 9358 divided by 75 = 125 children

Base on today’s measurement and the sink & toilet availability, the capacity is limited to 45 children. Center has sufficient activity space to support the requested capacity of 45 children.

Fire Clearance from Fire Authority has been received and approved for capacity of 45 children.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2015
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: CRESCENT HEAD START
FACILITY NUMBER: 304370976
VISIT DATE: 04/28/2015
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The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Water dispensers will be available in each room. Water fountain is observed in the playground for outside
drink.
. Playground is enclosed by appropriate fence.
· Outdoor activity area is supplied with age and size appropriate equipment
· Adequate shade is provided by tree and sun shelter was observed over the sandbox.
· Food preparation area is equipped with refrigerator; sink with hot and cold running water; storage area;
utensils; and adequate amount of food supplies
· The office area is located by the main entrance and will temporarily serve as the isolation area for
ill children until parents arrive.
· Staff bathroom will also be used as the isolation bathroom and is conveniently located to the
isolation area.
· Medication will be stored in the blue backpack in each room and is inaccessible to children.
· First Aid kit is complete.

Applicant was notified about disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, SIDS and Never Shake a Baby. Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if serious violations are cited then the Licensing Report (LIC 809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed. Applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00 per day per person will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation within a 12 month period, the fine will continue for up to 30 days.

Facility meets all requirement and file will be submitted for approval as of today.

Web address for downloading forms or regulations was provided as (http://ccld.ca.gov/PG411.htm).

Exit interview was conducted and a copy of this report was provided to the director on this date.
A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2015
LIC809 (FAS) - (06/04)
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