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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270871
Report Date: 01/17/2023
Date Signed: 01/17/2023 10:52:07 AM

Document Has Been Signed on 01/17/2023 10:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:NMUSD WILSON PRESCHOOLFACILITY NUMBER:
304270871
ADMINISTRATOR:CAMERO, MACYFACILITY TYPE:
850
ADDRESS:801 WILSON STREETTELEPHONE:
(949) 515-6995
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 13DATE:
01/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michelle O'Neill, CoordinatorTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Mila Quinto and Cindy Nguyen conducted a Case Management inspection. LPAs met with coordinator, Michelle O’Neill at the time of the visit. Upon arrival at 9:11am, LPAs observed 1 staff and 13 children in care in classroom 17. At 9:16am, Director arrived in the classroom. A review of staff criminal clearance records 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.

Based on LPAs observations and interview, the following violation was observed and being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101216.3(a) is being cited on the attached LIC 809D.



An Inspection and exit interview was completed with facility representative. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. If the facility receives a Type A violation, the facility shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the facility shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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Document Has Been Signed on 01/17/2023 10:52 AM - It Cannot Be Edited


Created By: Mila Quinto On 01/17/2023 at 10:25 AM
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: NMUSD WILSON PRESCHOOL
FACILITY NUMBER: 304270871

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2023
Section Cited
CCR
101216.3(a)

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101216.3 Teacher-Child Ratio
(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.
This requirment is not met as evidenced by:
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The coordinator stated they will ensure there are coverage to meet the ratio.
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During today's inspection, upon LPAs arrival of 9:11am, LPAs observed 1 preschool teacher with 13 preschool children. At 9:16am, director arrived in the classroom. This poses an immediate safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023


LIC809 (FAS) - (06/04)
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