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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370981
Report Date: 03/08/2019
Date Signed: 05/07/2021 02:51:52 PM

Document Has Been Signed on 05/07/2021 02:51 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GRATITUDE GARDEN PRESCHOOLFACILITY NUMBER:
304370981
ADMINISTRATOR:RICE, ERINFACILITY TYPE:
850
ADDRESS:92 AVENIDA LA PATATELEPHONE:
(949) 572-4453
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92673
CAPACITY: 55TOTAL ENROLLED CHILDREN: 0CENSUS: 48DATE:
03/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director: Erin Rice TIME COMPLETED:
02:45 PM
NARRATIVE
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***This is an amendment report to update the citation from type A to type B violation. This amended report is being delivered by Licensing Program Analyst (LPA) Ryan Chan for an inspection conducted by LPA Connolly***

An Annual Inspection was made today by Licensing Program Analyst (LPA) Connolly. Upon arrival the LPA met with director Erin Rice who accompanied on a tour of the facility. Census was taken. There were 48 children present with 6 attending staff. The facility is operating within its licensed capacity. A review of staff 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.

The facility, clean and orderly, was toured inside and outside. Operating hours are Monday through Friday 7:00 AM to 5:30 PM. The LPA reviewed that items which could pose a danger to children (detergents, cleaning compounds, medications) are stored out of the reach of children.

The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary.

The facility has conducted an emergency drill within the past six months. Documentation was provided. At least one staff member present possesses current CPR/First Aid certifications which expire 2/2020.

Lunch is brought from home. Snacks are provided by the facility. Food prep areas appear clean and sanitary. Food is properly stored. On site kitchen is free from hazards. Snack menu is posted.

Children nap on mats. Bedding provided by the facility is laundered at home as needed and weekly.
Continued on page two
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Ryan Joseph Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2019
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GRATITUDE GARDEN PRESCHOOL
FACILITY NUMBER: 304370981
VISIT DATE: 03/08/2019
NARRATIVE
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Page Two
The outdoor playground is fenced. Playground equipment is in good condition. Sand placed under high climbing equipment as cushioning material to absorb falls has eroded and has scattered leaving a hard sand surface.

Sign in/out procedure was reviewed for compliance. Children and staff files were reviewed for compliance. There are certificates for staff having completed the mandated reporter training. Proof of immunity to Measles and Pertussis as well as documentation related to influenza prevention was reviewed for compliance.

Incidental Medical Services (IMS) policy was discussed. This facility cares for children who need incidental medical services. LPA reviewed storage of medication and equipment/supplies and reviewed children personnel and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

Director submitted an updated personnel report (LIC 500) and an updated designation of responsibility (LIC 308).

In the areas that were evaluated the facility was not in compliance and a violation of the California Code of Regulations, Title 22, Division 12 was observed, discussed and cited at the time of the inspection. California Code of Regulations 101238.2 (e)91) Title 22, Division 12 is being cited on the attached LIC 809 D.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.The director shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100.00. The 'Notice of Site Visit' ' must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a civil penalty of $100.00.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Ryan Joseph Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2019
LIC809 (FAS) - (06/04)
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Document is an Amendment of Original Document on 05/07/2021 02:02 PM


Created By: Ryan Joseph Chan On 03/08/2019 at 01:48 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GRATITUDE GARDEN PRESCHOOL
FACILITY NUMBER: 304370981

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/15/2019
Section Cited
CCR
101238.2(e)(1)

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101238.2(e)(1) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. Sand as a cushioning material is permitted. This regulation has not been met as the sand underneath the high
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The director said the maintenance crew will inspect today in order to provide sand as a cushioning material to absorb a fall.
The director said this facility will be in compliance by Friday 3/15/19 and children will not have access to the climbing structure until the regulation is met.
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climbing structure has scattered and is not sufficiently placed underneath the climbing structure to be a cushioning material to absorb a fall.
This poses a potential risk to the health and safety of 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:Rina Lopez
LICENSING EVALUATOR NAME:Ryan Joseph Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2019


LIC809 (FAS) - (06/04)
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