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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610675
Report Date: 09/13/2023
Date Signed: 09/13/2023 02:46:12 PM

Document Has Been Signed on 09/13/2023 02:46 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:CAPISTRANO USD/SAN JUAN STATE PRESCHOOLFACILITY NUMBER:
300610675
ADMINISTRATOR:BRIERLEY, NENAFACILITY TYPE:
850
ADDRESS:31642 EL CAMINO REAL, #3TELEPHONE:
(949) 493-4533
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 20DATE:
09/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Heidi ArgentTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Dean Thompson conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 9/8/2023. LPA met with teacher Heidi Argent. LPA observed 20 preschool age children with 4 preschool age staff.

A review of staff criminal clearance records 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.

On 9/8/2023 a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that the classroom teacher grabbed two students by the arms. Another witness indicated that the teacher had grabbed students on another day. Witnesses indicated that the teacher turned the lights off in the classroom and left the students in the dark. Witnesses also reported that the teacher yelled at parents and students.

During today’s visit, LPA obtained an updated copy of the children’s roster and reviewed children files. Due to insufficient information available at this time, the reported incident needs further investigation.

Exit interview was conducted. The Notice of Site Visit was posted. Teacher Heidi Argent was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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