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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270351
Report Date: 05/07/2025
Date Signed: 05/07/2025 01:16:34 PM

Document Has Been Signed on 05/07/2025 01:16 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:RANCHO VIEJO SCHOOL, THEFACILITY NUMBER:
304270351
ADMINISTRATOR/
DIRECTOR:		WARKENTIEN, DEBORAHFACILITY TYPE:
850
ADDRESS:29782 AVENIDA DE LAS BANDERASTELEPHONE:
(949) 459-0199
CITY:RANCHO STA MARGARITASTATE: CAZIP CODE:
92688
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 43DATE:
05/07/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Director Deborah WarkentienTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analysts (LPA) Giselle Lucero conducted an unannounced case management visit to issue deficiencies observed during a subsequent visit on 04/11/2025. LPA observed a total of 33 preschool children with 4 staff in the classrooms and 10 toddlers with 2 staff in the classroom.

A review of 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.

On 04/11/2025, LPA reviewed children's medication that was stored at the facility. LPA observed Child #1's (C1) Epi-pen and medication to be expired. Epi-Pen expired on November 2024 and medication expired on July 2024. Facility did not have current medication for C1 stored at the facility. Also on 04/11/2025, during a complaint investigation, staff interviews were conducted, staff disclosed staff are made aware of children's allergies based on the allergy lists that are posted in the classrooms. During interview with the Director, Director stated there are no allergy lists posted in the classrooms. LPA conducted a physical plant inspection on 04/11/2025, LPA observed Child #2's (C2) allergy was the only allergy list posted in a classroom, the facility currently has 3 children with allergies.

Based on LPAs' observation and interviews, the following deficiencies were observed in accordance to California Code and Regulations, Tittle 22, Division 12, Title 22, Chapter 1 Health-Related Services 101226(e)(3)(A) and Health and Safety Code 1596.885(c); please see attached 809D for deficiencies.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Deborah Warkentien.
End of Report.
NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/07/2025 01:16 PM - It Cannot Be Edited


Created By: Giselle Lucero On 05/07/2025 at 12:09 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: RANCHO VIEJO SCHOOL, THE
FACILITY NUMBER: 304270351

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2025
Section Cited
CCR
101226(e)(3)(A)

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101226 Health-Related Services (e) In centers where the licensee chooses to handle medications(3) Prescription medications may be administered if all of the following conditions are met (A) Prescription medications shall be administered in accordance with the label directions as...
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Director returned expired medication to parent. Director also stated they will check medication expiration dates monthly to ensure medications do not expire.
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 prescribed by the child's physician. Based on observation, the licensee did not comply with the section cited above. C1 had an expired epi-pen and medication stored at the facility. This poses a potential health, safety or personal rights risk to persons in care.
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Type B
05/09/2025
Section Cited
HSC1596.885(c)

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1596.885(c) Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state. Based on observation and interviews, the licensee did not comply with the section cited above.
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Director stated she does not think her staff are liars, staff must have been confused or nervous because an allergy list was posted in the past. Director stated she will remind staff if they are unsure of something, it is okay for staff to respond, "I don't know" rather than feel forced to give an answer. Director will...
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Staff stated children's allergies are posted in the classroom. LPA did not observe all children's allergies posted. This poses a potential health, safety or personal rights risk to persons in care.
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send a memo to all staff and send a copy to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Giselle Lucero
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2025


LIC809 (FAS) - (06/04)
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