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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610675
Report Date: 04/19/2024
Date Signed: 04/19/2024 12:25:01 PM

Document Has Been Signed on 04/19/2024 12:25 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/
DIRECTOR:		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: 23DATE:
04/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Principal/On Site Asministrator Guadalupe ManzanillaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 04/19/2024, Licensing Program Analyst (LPA) Romy Castanon conducted a Case Management due to information provided to LPA during visit on 01/29/2024. LPA met with Principal/On Site Administrator Guadalupe Manzanilla and explained the reason for today’s visit. Director/Off Site Administrator Lauren Pattulo joined via telephone conference call.

A review of the Facility Personnel Report Summary on 04/19/2024 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During LPA’s visit on 01/29/2024, LPA interviewed five (5) staff members. During interviews, 4 out of 5 staff stated they have witnessed Staff #1 (S1) raise their voice at the children. 3 out of 5 stated they have heard S1 raise their voice or yell at children almost every day. Staff mentioned S1 will use a very loud stern voice and instruct the children to be quiet. Staff stated they have adapted to the intensity or volume of S1’s voice. LPA also observed and heard S1 speaking to children in a loud and direct manner throughout their facility visit.

Based on LPA’s observation and interview with 4 staff members, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101223 (a)(3) Personal Rights is cited on the attached LIC9099D.

Appeal Rights were discussed. The facility representative 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 Principal/On Site Administrator Guadalupe Manzanilla. 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: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2024
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 04/19/2024 12:25 PM - It Cannot Be Edited


Created By: Romelia M Castanon On 04/19/2024 at 10:49 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: 04/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/22/2024
Section Cited
CCR
101223(a)(3)

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101223 (a)(3) Personal Rights (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions...This requirement has not been met as evidenced by:
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Director Pattulo will schedule a early learning coach and contracted mental health & behavior support speacilaist to provide training addressing appropriate behavior in the classroom. Director Pattulo will submit a plan of action and includes dates of training to LPA by 05/01/2024.
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During LPA’s visit on 01/29/2024, LPA interviewed five (5) staff members. During interviews, 4 out of 5 staff stated they have witnessed S1 raise their voice at the children. LPA also observed S1 speak loud and direct to the children during their visit. This is an immediate personal rights risk to persons 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: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024


LIC809 (FAS) - (06/04)
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