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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370133
Report Date: 12/21/2023
Date Signed: 12/21/2023 10:52:05 AM

Document Has Been Signed on 12/21/2023 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:DON AVILA ELEMENTARYFACILITY NUMBER:
304370133
ADMINISTRATOR:HAYES, NATALIEFACILITY TYPE:
850
ADDRESS:26278 WOOD CANYONTELEPHONE:
(949) 234-5342
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 14DATE:
12/21/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Natalie Hayes, Site SupervisorTIME COMPLETED:
11:15 AM
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On 12/21/2023, Licensing Program Analyst (LPA), Mila Quinto conducted an unannounced Case Management inspection for a decrease in capacity. Upon arrival, LPA met with Site Supervisor, Natalie Hayes. The facility is requesting to be licensed for 24 preschool children,ages 3 years old thru 5 years old in classroom 408. Hours of operation will be Monday – Friday, 8am to 3pm. Present during today’s inspection were 14 preschool children with 3 staff. Appropriate ratios and supervision were observed. All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Natalie Hayes that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities.

LPA continued to tour the facility and measured the indoor and outdoor activity space. Total indoor activity space measured at 730.32 square feet, which can accommodate the capacity of 21 children. LPA observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, napping mats, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms with children’s bottled water with their names on them. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance is pending for the requested decrease capacity.

LPA observed two sinks and three toilets in the girls bathroom and there are two sinks, one toilet, and two urinals in the boys bathroom. There is one sink in each classroom as well.



Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment including slide. The total square footage of the outdoor activity space is 8661.62 square feet. There are adequate amount of cushioning material in place under the equipment. There is a waiver to share the playground with kindergarten children from elementary school on a different schedule time. Shade is provided by an awning. Drinking water is available to children by drinking fountain. The are no hazardous items on the playground. Facility representative was reminded that any changes to the facility must be reported to and approved by Community Care Licensing. Page 1 of 2
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DON AVILA ELEMENTARY
FACILITY NUMBER: 304370133
VISIT DATE: 12/21/2023
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Based on measurements obtained both indoors and outdoors, the facility capacity will be reduced to 21. The licensee has requested to reduce capacity by removing room 407. The licensee requested a decrease in capacity from 48 to 24. However, based on the measurements obtained the facility capacity allows for 21 children.

The request for a capacity decrease will be submitted for final review. The facility will be notified if any additional information is required.

A notice of site visit was given to Natalie Hayes and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to post will result in civil penalties of $100.00

An exit interview was conducted with the Site Supervisor, Natalie Hayes. Appeal Rights was 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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC809 (FAS) - (06/04)
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