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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371061
Report Date: 01/28/2026
Date Signed: 01/28/2026 03:06:00 PM

Document Has Been Signed on 01/28/2026 03:06 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ST. JUNIPERO SERRA CATHOLIC PRESCHOOLFACILITY NUMBER:
304371061
ADMINISTRATOR/
DIRECTOR:		BENTLEY, MICHELLE A.FACILITY TYPE:
850
ADDRESS:23652 ANTONIO PARKWAYTELEPHONE:
(949) 888-1990
CITY:RANCHO STA MARGARITASTATE: CAZIP CODE:
92688
CAPACITY: 69TOTAL ENROLLED CHILDREN: 69CENSUS: 21DATE:
01/28/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Director, Michelle BentleyTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 1/28/2026 an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Kathy Trinh in response to a self-reported incident dated 1/23/2026. LPA met with Facility Representative Michelle Bentley and was led on a tour. There were 21 napping preschool children and 3 staff present at the time of inspection. Hours of operation are 6:45AM-6:00PM, Monday through Friday. A review of adult records 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 Department received an incident report on 1/23/2026 stating that on 1/23/2026 at 10:00AM, Staff 2 (S2) told Child 1 (C1) to go potty as they were transitioning from the classroom to the playground. S2 then grabbed the emergency backpack and forgot that C1 was still in the restroom. Staff 1 (S1) confirmed with S2 that the children were ready to go outside, and they transitioned to the playground. S1 then realized C1 was left behind and walked back to the classroom during their break. S1 saw C1 in the classroom alone crying in the restroom. Based on the video camera footage reviewed by the Director, C1 was alone in the classroom for a total of four (4) minutes.

During the investigation, LPA conducted interviews with two (2) staff members. Both staff interviewed confirmed that C1 was left unattended in the classroom bathroom for a few minutes after the rest of the class had made their way to the playground. The interviewed staff also shared that the staff present during the time of the incident did not count how many children they had as they transitioned from the classroom to the playground.

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NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: ST. JUNIPERO SERRA CATHOLIC PRESCHOOL
FACILITY NUMBER: 304371061
VISIT DATE: 01/28/2026
NARRATIVE
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(Page 2)
During the investigation, LPA also reviewed and obtained video camera footage that shows the classroom walking to the playground. The video footage indicates that the class had gone to the playground at approximately 10:00AM and S1 went back to the classroom for their break at approximately 10:06AM.

Following this incident, the Director had implemented a new transition procedure in which staff check off the names of the children as they transition from one place to another.

Based on the information gathered from the interviews with staff of the Unusual Incident Report dated 1/23/2026. The facility was not in compliance of the California Code of Regulations, Title 22, Division 12 101229(a)(1) Responsibility for Providing Care and Supervision. It was determined that 1 Type A citation will be cited during today’s visit; see LIC 809D for deficiency.

LPA K. Trinh informed Director Michelle Bentley that this report dated 1/28/2026 for Type A citation shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA K. Trinh informed Director Michelle Bentley to provide a copy of this licensing report dated 1/28/2026, Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director, Michelle Bentley. A notice of site visit was given and must remain posted for 30 days. Failure to post will result in civil penalties of $100.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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. First level appeals should be sent to the regional manager to the address listed above.
End of Report.
NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/28/2026 03:06 PM - It Cannot Be Edited


Created By: Kathy Trinh On 01/28/2026 at 02:38 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. JUNIPERO SERRA CATHOLIC PRESCHOOL
FACILITY NUMBER: 304371061

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/29/2026
Section Cited
CCR
101229

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101229(a)(1) Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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Director stated that they had implemented a new transition procedure for staff to follow. They will also hold a staff training to go over the supervision regulations. Director will email LPA the training sign in/out sheet by due date.
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Based on interviews and record review, the licensee did not comply with the section cited above in that, Child 1 (C1) was left alone in the classroom without teacher supervision, which poses an immediate health, safety or personal rights risk to persons 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.
Tina Nguyen
NAME OF LICENSING PROGRAM MANAGER:
Kathy Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2026


LIC809 (FAS) - (06/04)
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