304270114-8-11-2023-06-CC-MMAK-CULS73-20230811133654

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270114
Report Date: 08/11/2023
Date Signed: 08/11/2023 01:37:01 PM

Document Has Been Signed on 08/11/2023 01:37 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 UNIFIED SCHOOL DISTRICT-CLARENCE LOBO		FACILITY NUMBER:	304270114
ADMINISTRATOR:	MORROW, SUSAN		FACILITY TYPE:	850
ADDRESS:	200 AVE. VISTA MONTANA		TELEPHONE:	(949) 234-5341
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92672
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 0	DATE:	08/11/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Lauren Pattullo		TIME 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 3 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of the facility decreasing their capacity from 48 to 24 preschool children by removing room 7 off their license. LPA met with Lauren Pattullo the director of Early Childhood, General Education and Special Education Programs of Capistrano Unified School District who gave LPA a tour of the facility. The facility is located on the ground of Lobo Clarence Elementary School. The Site Supervisor of this site is Jessica Ponsen. There were no children present due to Summer Break. The school starts 8/15/2023. The facility is running Title 5 program and operating from 8.00 am to 3.00 PM, Monday to Friday serving children ages 3-5 years old offering two half day sessions in Room 2. A review of the Facility Personnel Report Summary 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. (The staff are employees of Capistrano Unified School District. Morning session is from 8:00am to 11:00 am and afternoon session is from 11:45 am to 2:45 pm. The facility provides morning breakfast and afternoon lunch to children. Children do not nap in this room. The children are dropped off and are singed in and out at the entrance manually. The facility has met all the posting requirements. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the nurse’s office, next to the school office, away from the other children, and use the adult restroom. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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 3

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 UNIFIED SCHOOL DISTRICT-CLARENCE LOBO	FACILITY NUMBER: 304270114
	VISIT DATE: 08/11/2023

NARRATIVE

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Following was observed in room 2:
Age appropriate furniture and activities including educational, arts and crafts items.
Room is well ventilated with proper lighting and shade.
There is a working Smoke detector, Carbon Monoxide detectors and Fire Extinguisher.
Outdoor Activity Space: Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment with adequate of cushioning materials under the climbing structure, slide, and swings. Shade is provided by canopies, and building shade. The play yard is shared with TK and Kindergarten children. There is a gate on one side of the playground opening to parking lot which is locked at all times according to representatives. There is a waiver to share the playground on file.
Fire clearance approval is on file for room 2.
The measurement of room 2 is as below:

Room 2 is 899.93 square feet
Total indoor measurement for room 2 is 899.93 square feet divided by 35 square feet = 25.71
( 26 children).
Toilets: 2 X 15= 30 children
Sinks: 3 X 15 = 45 children.
There are 2 toilets, and 2 sinks in the Girls bathroom. There is one sink in room 2. The facility has a waiver to share restrooms on the Elementary Campus.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with applicant the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Continued on page 3

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 UNIFIED SCHOOL DISTRICT-CLARENCE LOBO	FACILITY NUMBER: 304270114
	VISIT DATE: 08/11/2023

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Licensee 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.

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 communication.

Exit interview conducted and report was reviewed with the licensee, Lauren Pattullo.

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

Based on today’s measurements, the sinks and toilets availability, the request of the facility for moving to room 2 with a capacity of 24 will be final reviewed and discussed with management in the Regional Office and after receiving the following corrections. The facility will be notified if any additional information is required.

1- Securing the children's items such as one tall wooden shelf in dramatic area.
2- Signs for the bathrooms to state "preschool" in the shared restroom.
3- Complete list of site supervisor packet for this facility. Items on the list was given to the licensee.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC809 (FAS) - (06/04)

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