304270640-2-13-2023-06-CC-MMAK-CNZRW4-20230213122231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270640
Report Date: 02/13/2023
Date Signed: 02/13/2023 12:22:37 PM

Document Has Been Signed on 02/13/2023 12:22 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:	PILLARS ACADEMY		FACILITY NUMBER:	304270640
ADMINISTRATOR:	KAZI, ZUBEDA		FACILITY TYPE:	850
ADDRESS:	23581 MADERO DRIVE # 104		TELEPHONE:	(949) 951-0442
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 34	DATE:	02/13/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director		TIME 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	Page 1 of 2 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of increasing capacity from 48 children to 60 children by changing the toddler option room, and switching rooms. The facility is currently licensed in rooms 105 A, and 105B, and 12 toddlers from Toddler Option Component in Room 103A. The private elementary room is room # 103. LPA met with director, Zubeda Kazi who toured the facility with LPA. Census was taken. There were a total of 24 preschool children with 4 staff and 10 children from Toddler Option Component with 2 staff. The facility has requested to provide care and supervision for a total capacity of 60 children (44 preschool children ages 3 to 5 years old, and 16 toddlers from Toddler Option Component ages 18 to 36 months old, Monday through Friday, 7:00 a.m. to 6:00 p.m. 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 director 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, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The parents provides snacks and lunch to their children. The children are dropped off and are singed in and out at the entrance electronically. The facility has met all the posting requirements. Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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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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: PILLARS ACADEMY	FACILITY NUMBER: 304270640
	VISIT DATE: 02/13/2023

NARRATIVE

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The classrooms were measured as follows:
Room # 103 (Toddler Option Room) 418 square feet that accommodates 11.94 children (12 toddlers).
Room # 103 A : 484 square feet divided by 35 = 13.82 (14 children)
Room # 105 A: 468 square feet divided by 35 = 13.37 (13 children)
Room # 105 B: 616 square feet divided by 35 = 17.6 (17 children)
Room # 105 is the private elementary classroom which is not under the Department's jurisdiction. The facility has a private school affidavit for this room and is on file.
Total indoor space for rooms 103A, 105 A, and 105 B: 1568 divided by 35 are: 1568 square feet divided by 35 = 44.8 ( 44 children), and total space room for toddler Option is: 418 square feet. The total capacity accommodates 56 children.
Toilets: 4 X 15 = 60 children
Sinks: 6 X 15 = 90 children
Total outdoor activity space measurement is as follows:
The total measurement of two playgrounds are 6648 square feet divided by 75 square feet which accommodates 88.64 (89 children). The part of the playground has been set up and separated for younger preschool children and toddlers from Toddler Option Component, and the other part of the playground is set up with a higher climbing structure for older preschool children and private elementary children. The facility has a waiver to share the playground with toddlers and private elementary and preschool children at different time of the day. The facility has fenced the appropriate younger equipment off for younger children from the other playground. The waiver is approved as of 11/2016. The facility will follow the waiver scheduling.
The facility is equipped with carbon monoxide detector.
LPA discussed the safe sleep regulations with director, and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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: PILLARS ACADEMY	FACILITY NUMBER: 304270640
	VISIT DATE: 02/13/2023

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The director was informed of checking children under 24 months old every 15 minutes and logging them in during nap time. A sample of the log was given to the director. The director was also informed the maximum group of toddler option with two staff is 12 toddlers. Each group should not exceed 12 toddlers.

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)/ (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

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 platform.

Orange county Fire authority has approved the requested total capacity of 60 children including 16 toddlers but based on the classroom measurements, outdoor space, and number of toilets and sinks, the facility meets the requirements for 44 preschool children in rooms 103A, 105A, and 105 B, and 12 toddlers from Toddler Option Component in room # 103. Room # 105 is private elementary classroom. This request will be final reviewed and discussed with management in the Regional Office. The facility will be notified if any additional document is required.

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.

The following are needed before an updated license is issued: Please submit them to LPA no later than 30 days of today's date.

1- Wavier request to share the restroom of the facility for the toddler option program with preschool program. There are 2 toilets and one sink in the restroom that will be shared with each other. Please send the following with your request letter to our office. LIC 999, LIC 500, posting pictures on the restroom wall to designated the stall for Toddler Option Component.

Exit interview conducted and report was reviewed with the director, Zubeda Kazi.

End of report

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC809 (FAS) - (06/04)

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