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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610675
Report Date: 10/25/2023
Date Signed: 10/25/2023 10:32:24 AM

Document Has Been Signed on 10/25/2023 10:32 AM - 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: 15DATE:
10/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Heidi ArgentTIME COMPLETED:
10:50 AM
NARRATIVE
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On 10/25/2023, Licensing Program Analysts (LPA’s) Dean Thompson and Karen Navar 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 at 9:29 a.m. When LPA’s arrived, LPA’s observed 14 preschool age children with 1 preschool age staff. 101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.

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 staff member 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 the investigation, LPA interviewed staff, interviewed parents, and obtained documentation.

Based on supporting information received and interviews, children’s personal rights were violated.

The following deficiencies were observed and cited today per CA Code of Regulations, Title 22, Division 12 (See LIC 809-D for specific deficiencies).

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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Document Has Been Signed on 10/25/2023 10:32 AM - It Cannot Be Edited


Created By: Dean Thompson On 10/25/2023 at 09:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAPISTRANO USD/SAN JUAN STATE PRESCHOOL
FACILITY NUMBER: 300610675

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/01/2023
Section Cited
CCR
101223(a)(1)

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101223 Personal Rights(a)The licensee shall ensure that each child is accorded the... personal rights: (1)To be accorded dignity... personal relationships with staff...

This requirement is not met as evidenced by
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Director and staff will watch personal rights and supervising children in childcare center videos. The Director will submit in writing proof of completion with the names and dates of all staff who completed the videos. Director will also submit a detailed email or written letter describing what plan of action the facility will address to go over the incident with staff and address compliance with children's personal rights by 11/1/2023.

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Based on interviews conducted with parents and staff as well as documentation received, a teacher handled a child/children in a rough manner. This is an immediate risk to the personal rights to the children in care.
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https://ccld.childcarevideos.org/child-care-center-operators/supervising-children-in-child-care-centers/

https://ccld.childcarevideos.org/child-care-center-operators/childrens-personal-rights-in-child-care/
Type A
10/25/2023
Section Cited
CCR101216.3(a)

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101216.3 Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance...

This requrement is not met as evidenced by.
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LPA's observed staff get back into ratio during the visit. Director and staff will watch Teacher-to-Child Ratios in Child Care Centers

https://ccld.childcarevideos.org/child-care-center-operators/teacher-child-ratios-in-child-care-centers/
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LPA met with teacher Heidi Argent at 9:29 a.m. When LPA’s arrived, LPA’s observed 14 preschool age children with 1 preschool age staff. Teacher stated she understands the ratio but a child had to use the restroom. Teacher was left with 14 children as the assistant assisted a child to the restroom.
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The Director will submit in writing proof of completion with the names and dates of all staff who completed the videos.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023


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: CAPISTRANO USD/SAN JUAN STATE PRESCHOOL
FACILITY NUMBER: 300610675
VISIT DATE: 10/25/2023
NARRATIVE
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Type A citation

LPA Thompson informed facility representative Heidi Argent that this report dated 10/25/2023 document(s) two Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Thompson informed the facility representative Heidi Argent to provide a copy of this licensing report dated 10/25/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with Heidi Argent. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Appeal Rights discussed. Heidi Argent was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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