<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300611507
Report Date: 03/27/2023
Date Signed: 03/27/2023 12:33:32 PM

Document Has Been Signed on 03/27/2023 12:33 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:BOOTH, CHRISFACILITY NUMBER:
300611507
ADMINISTRATOR:BOOTH, CHRISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 492-3004
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
03/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Chris BoothTIME COMPLETED:
01:00 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
An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Bootorabi. A. An Entrance Checklist (LIC 126) was provided to the licensee Chris Booth upon arrival.

Census upon entry at 9:00 am
Infants: 0
Children Over Two: 2
Adults Working Directly with Children: 2
Other Adults: 0
The licensee was operating within the licensed capacity as specified on the license. The Facility Day care hours are 9 am-12 pm, Monday through Friday. Licensee offers a M/W/F and T/TH program for children 3 years and up.

During today’s inspection, LPA observed the children coming in to the program with their parents. Parents sign-in and check temperatures upon entry. Children walk through the garage that is used for storage to get to the outdoor play area and classroom (bedroom #1 ).

Upon arrival, the LPA verified that the following documents were posted in a prominent, publicly accessible area; License was posted behind the main entrance door. LIC 9148 Earthquake Preparedness and PUB 394 Notification of Parents’ Rights were posted behind the garage door where parents check-in. A consultation on posting documents in a prominent and easily visible area was conducted.



Page 1
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2023
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 7
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: BOOTH, CHRIS
FACILITY NUMBER: 300611507
VISIT DATE: 03/27/2023
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
26
27
28
29
30
31
32
 Facility Tour was conducted at 9:05 am.The LPA and Chris Booth toured the facility inside and outside. The facility sketch (LIC 999) was verified. Areas stated to be off-limits by the facility sketch were made off limits by closed doors and supervision.

Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children by means of being stored in areas children cannot reach. Knifes and cleaning compounds were stored in cabinets high enough where children do not have access to them. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections.


Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. The children's bathroom is clean and sanitary. The children do not nap in the program as it ends at noon. Licensee state when children are too tired to be in care their parent is contacted for earlier pick up time.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The outdoor play area has one pretend house the size of a storage room with windows, and a door. The surface of the outdoor activity space was maintained and free of dangerous hazards to children. Licensee stated that children are always supervised during care to ensure they do not climb storage #1 outside that has stairs and storage #3 is blocked with a large table and can also be locked. LPA confirmed that both storage have toys, balls and does not have harmful material that can pose a risk of health and safety of children.

The licensee tested the carbon monoxide and smoke detector during today’s inspection. Both were functioning. The licensee and LPA reviewed the Fire Extinguisher and marked in full.


Records Reviewed at 9:54 am. The LPA requested to review the LIC 610A Emergency Disaster Plan, Verification of Disaster and Fire Drills, and LIC 9040 Facility Roster. The licensee met the requirements during the inspection and LPA reminded the licensee of the importance of keeping documents up to date to comply consistently. Licensee will update Roster.

Page 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: BOOTH, CHRIS
FACILITY NUMBER: 300611507
VISIT DATE: 03/27/2023
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
26
27
28
29
30
31
32
Personnel Records were reviewed at 10:15 am. The LPA requested completed personnel records 3 out of 3 adults working with the children for review during today’s inspection. The following documents were reviewed in the files provided by the licensee; CPR First Aid Certification, LIC 9052, Immunization records, TB clearance and LIC 9108, and a Mandated Reporter Training Certificate. CPR for licensee expires 12/28/23. Mandated reporter training was in compliance for the license and assistant #1. Assist #2 first day is today and will complete training this week and TB test clearance will also be submitted to LPA.

Children’s Records Reviewed at 10:50 am. TheLPA requested completed children’s records of children enrolled. Children's records were reviewed, and there was separate, complete, and current record for each child. The LPA reviewed files to verify the following documents, Immunization Records, LIC 700 Identification and Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights.

A facility License File Review was conducted at 11:34 am. The LPA asked Licensee if there are any updates to be made for LIC 279, LIC 610, or LIC 999. Licensee stated there were no changes or updates at this time.

Incidental Medical Services (IMS) policy was discussed and the licensee stated she does not provide IMS currently in her FCCH. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department.


The following information regarding ADA was provided:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY)

Commonly Asked Questions American Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Know the Law About The Americans with Disabilities Act and Individuals with Disabilities Education Act https://rrnetwork.org/assets/general-files/Child-Care-Law-Center-ADA_IDEA_Housing-April-2019.pdf page 3

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: BOOTH, CHRIS
FACILITY NUMBER: 300611507
VISIT DATE: 03/27/2023
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
26
27
28
29
30
31
32
A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, there are 2 adults including the licensee and 0 minor child living in the facility. The licensee was reminded that any individuals 18 years or older must have a background check clearance. The licensee was also reminded that any children turning 18 years must obtain a background check to maintain compliance.

CCLD website www.ccld.ca.gov was provided to licensees to access regulations, updates, and licensing forms.

The licensee was informed of the important updates available at www.ccld.ca.gov and may request to be added to an email list to receive Community Care Licensing Important Notifications from the above website and selecting Receive Important Updates: https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

The licensee understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR/First Aid, and mandated reporter training.

In the areas that were evaluated, NO deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Licensee was reminded to update documents as needed and a consultation was provided. Licensee was also reminded to keep all dangerous items out of reach of children.


Page 4
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: BOOTH, CHRIS
FACILITY NUMBER: 300611507
VISIT DATE: 03/27/2023
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
26
27
28
29
30
31
32
An exit interview was conducted with licensee. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

End of Report.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7