Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370976
Report Date: 09/04/2015 12:00:00 AM
Date Signed 09/04/2015 12:30:09 PM

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:
09/04/2015
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Division Director Operation Valerie PadillaTIME COMPLETED:
12:45 PM
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A case management visit was conducted on this date by LPA Ho. The purpose for today’s visit was to evaluate the facility for a capacity decreased. Facility is currently licensed for 45 children and requesting to decrease capacity to 30 children. Room # 4 & 5 will be used for the preschool program. Room #1, 2, 3 will be used for the infant program. LPA met with Division Director Operation, Valerie Padilla. First day of school will be September 14, 2015. No children present.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, and mat/cot were inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, and criminal records clearances/exemption transfer requests, SIDS and Never Shake a Baby

Measurements are taken as follows:
Indoor space:
Room # 4 = 28'3 x13'5 = 384.75'
18'3 x 5'8 = 105'
5'2 x 4'6 = 23'
Total: 384.75' + 105' + 23" = 513 divided by 35' = 15 children
Room #5 = 17'6 x 22'6 = 393.75'
18'11 x 12'4 = 233'
Total: 393.75' + 233' = 626' divided by 35' = 17 children
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2015
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: 09/04/2015
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Toilets: 2 x 15 = 30 children
Sinks: 4 x 15 = 60 children

Outdoor space:
30'4 x 40'9 = 1235'
60'5 x 82'1 = 4957'
Total outdoor space: 1235' + 4957' = 6192 divided by 75 = 82 children.

Based on today’s measurements, facility will be decreased to 30 children.

After a tour of the center and review of children's records, no deficiency was observed .

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

Exit interview conducted. Notice of Site Visit was posted. Division Director of Operation was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2015
LIC809 (FAS) - (06/04)
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