300610675-8-23-2024-06-CC-MMAK-D8ERTD-20240823131809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300610675
Report Date: 08/23/2024
Date Signed: 08/23/2024 02:47:25 PM

Document Has Been Signed on 08/23/2024 02:47 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 PRESCHOOL		FACILITY NUMBER:	300610675
ADMINISTRATOR/ DIRECTOR:	ARGENT, HEIDI		FACILITY TYPE:	850
ADDRESS:	31642 EL CAMINO REAL, #3		TELEPHONE:	(949) 493-4533
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 12	DATE:	08/23/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:15 AM
MET WITH:	Staff in charge Maria Medina		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Page 1 of 4 Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite inspection for the purpose of Annual inspection. LPA met with staff in charge, Maria Medina and her assistant who had just dismissed 13 preschool children of morning session. The staff were in preparation of afternoon session which starts at 12:10 pm. During inspection 12 preschool children arrived at the gate at 12:10 pm under supervision of two staff. LPA toured of the facility inside and outside. The floor and yard plan (LIC 999) were checked. This State Preschool Program in Room 42 runs Title 5 program and is located on San Juan State Elementary School Site. The facility is not using Room 43 any longer. They have submitted and application for closing Room # 43 and decreasing capacity which is in pending status. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility operation hours are in two morning and afternoon sessions. Morning session is from 8:10 to 11:10 am and afternoon session is from 12:10 to 3:10 pm. Monday through Friday. Parents sign their children in and out manually at the gate at drop off and pick up with the presence of staff. 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. (The staff are employees of Capistrano Unified School District and they are exempt of this requirements). During the inspection of the indoor activity space, items which could pose a danger to children (cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. The facility provides lunch for morning and afternoon sessions. The Continued to page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

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: 08/23/2024

NARRATIVE

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required licensing posting were in compliance. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. Drinking water is available to children indoors by water containers that children bring from home and the facility fills them out from the water filtered dispenser. There are no sinks in this portable # 42. Preschool children do not nap in this program because the program is part time.

The facility has been conducted an emergency drill within the past six months. The last fire drill was conducted 5/18/2024. The facility has a working carbon monoxide detector and fire extinguisher.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material on the preschool playground is appeared to be enough to absorb falls.(wood chips). There is enough cushioning underneath and around the falling zones of play structure and slide. The facility has a waiver in place to share the playground with younger children of this elementary school . There is also another waiver to share the restroom with elementary children. Drinking water in the outdoor activity space is provided by water containers children brought from home and the facility fills them up with water from the filtered water dispenser. The outdoor equipment and toys were in good repair and free of sharp edges. Shade is provided. There are no bodies of water present at the facility.

Staff files were reviewed for staff present during the facility inspection on this date, 2 staff files were reviewed. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a childcare center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed for compliance.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. The certificates were reviewed for compliance. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which all were all in compliance.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 08/23/2024

NARRATIVE

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Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 5 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in compliance.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). However, the facility is using drinking filtered water from water dispenser from a private water company. There are no sinks in the rooms for drinking or food preparation in the portable. Facility has submitted attestation to Orange County Office for being exempt of this requirement which is pending.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301(voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at:https://www.ada.gov/resources/child-carecenters

The facility representative, Maria Medina was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing Continued on page 4

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 08/23/2024

NARRATIVE

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clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communications.

The facility representative, Maria Medina was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the

email address provided. Please complete the survey and share your inspection experience. If
you have any questions regarding the process or CARE tools, please send email inquiries to
inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its
tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

A notice of site visit was given to facility representative, Maria Medina and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

In the areas that were evaluated, no deficiency of the California Code of Regulations, Title 22, Division 12 was cited on this inspection date.

Exit interview conducted and report was reviewed with the facility representative, Maria Medina.

End of report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024

LIC809 (FAS) - (06/04)

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