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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610675
Report Date: 01/29/2024
Date Signed: 01/29/2024 01:35:51 PM

Document Has Been Signed on 01/29/2024 01:35 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CAPISTRANO USD/SAN JUAN STATE PRESCHOOLFACILITY NUMBER:
300610675
ADMINISTRATOR:ARGENT, HEIDIFACILITY TYPE:
850
ADDRESS:31642 EL CAMINO REAL, #3TELEPHONE:
(949) 493-4533
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 26DATE:
01/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Site Facilitator Heidi ArgentTIME COMPLETED:
02:15 PM
NARRATIVE
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On 01/29/2024, Licensing Program Analyst (LPA) Romy Castanon conducted a Case Management due to deficiencies observed during today's visit. LPA Castanon met with Site Facilitator (SF) Heidi Argent. Observed at the time of the visit was a total of 26 children and 4 staff members.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions, except for Aida Gurrola (start date: 01/16/2004). LPA informed SF staff above was not listed as associated to the facility on report summary. Upon further review of the staff personnel file, there is no documentation in relation to Staff Aida completing a background check. After reviewing two Licensing Department systems including Guardian, LPA determined a fingerprint clearance does not exist for Staff Aida. A civil penalty is being assessed today.

Based on LPA’s interview conducted with Site Facilitator and record review, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101170(e)(1) Criminal Background Clearance for one (1) staff not cleared to work at the facility.

Appeal Rights were discussed. The Site Facilitator 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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Site Facilitator Heidi Argent.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Licensee shall have LIC9224 (Acknowledgement of Receipt) signed and kept in each child's file. (End of Report)

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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 01/29/2024 01:35 PM - It Cannot Be Edited


Created By: Romelia M Castanon On 01/29/2024 at 12:27 PM
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: 01/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/30/2024
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement is not met as evidenced by:
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Site Facilitator (SF) contacted District Office to locate background clearance documents for Staff Aida Gurrola.SF agreed Staff Aida cannot return to the facility until a Guardian system clearance and association is granted. SF will send LPA Guardian screenshot that Staff Aida is cleared and has been associated to the facility via email.
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Based on LPA's record review and interviews, there is no criminal clearance Staff Aida Gurrola who has been employed at the facility since 01/16/2004.
This poses an immediate risk to the health and safety of children in care.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2024


LIC809 (FAS) - (06/04)
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