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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370846
Report Date: 12/16/2022
Date Signed: 12/16/2022 10:43:59 AM

Document Has Been Signed on 12/16/2022 10:43 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:NOBIS PRESCHOOLFACILITY NUMBER:
304370846
ADMINISTRATOR:NEITZKE, ASHLEYFACILITY TYPE:
850
ADDRESS:26153 VICTORIA BLVD.TELEPHONE:
(949) 661-6258
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 31DATE:
12/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Erica Benavides, Asst Director & Ashley Neitzke, DirectorTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) P Rivas conducted a case management visit based on information obtained 10/26/22. LPA was assisted by Ms. Erica Benavides, Asst. Director.
A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Director, Ashley Neitzke arrived during visit.

During today's visit census was taken. The facility has three classrooms under this license. Toddler classroom is solely for children 18 months up to 3 years old, depending upon development can move at 2 year years old to preschool . Preschool classroom has children ages 2 years old to 4 years old depending upon child's development. pre-K room is 4 years old to 5 years old.
In pre-K room there were 10 children and one fully qualified teacher. In preschool room there was one fully qualified teacher and a teacher's assistant and 15 children. In Toddler room there were 6 children, one fully qualified teacher and one teacher's assistant.

On 10/26/22 LPA noted " There were a total of 9 toddlers with 1 staff and 23 preschool aged children with 2 staff at the facility, at total of 33 children with 3 staff(not including 2 staff who were on break). This facility has a toddler component attached to the preschool license. "

Based on LPA's observation the facility was out of ratio on 10/26/22.
The following deficiency is cited under California Code of Regulations Title 22 Division 12 chapter 1
101216.3(c)(1)Teacher-Child Ratio adult-child ratio Child development programs funded by the California Department of Education and operating under Title 5 of the California Code of Regulations are not required to meet the teacher-child ratios specified in (a) and (b) above. Title 5 staffing ratios shall apply in such centers. (B)Toddlers (18 months to 36 months old) - 1:4
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2022
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 12/16/2022 10:43 AM - It Cannot Be Edited


Created By: Pat Rivas On 12/16/2022 at 09:48 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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/26/2022
Section Cited
CCR
101216.3(c)

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Teacher-Child Ratio adult-child ratio Child development programs funded by the California Department of Education and operating under Title 5 of the California Code of Regulations are not required to meet the teacher-child ratios specified in
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director states they keep in compliance with ratios, All staff are familiear with ratios before start of breaks get numbers of children in each classroom. If teacher is going to be out of ratio (parent still present) staff contact director and asst director for back up; all am staff present by 8am. plan
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(a) and (b) above. Title 5 staffing ratios shall apply in such centers. (B)Toddlers (18 months to 36 months old) - 1:4; this requirement was not met as evidenced by lpas observation on 102622 ;there were a total of 9 toddlers with 1 staff and 23 preschool aged children with 2 staff at the facility, at total of 33 children with 3 staff(not including 2 staff who were on break)
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to be written and provided to LPA by plan of correction date.

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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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2022


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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846
VISIT DATE: 12/16/2022
NARRATIVE
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An exit interview was completed with Director Ashley Neitzke. 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

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: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC809 (FAS) - (06/04)
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