304371120-10-31-2023-06-CC-MQUO-CX5RGA-20231031130025

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371120
Report Date: 10/31/2023
Date Signed: 10/31/2023 01:00:31 PM

Document Has Been Signed on 10/31/2023 01:00 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:	COMMUNITY CARE CLUB @ COMMUNITY ROOTS ACADEMY		FACILITY NUMBER:	304371120
ADMINISTRATOR:	WALTERS, MARIA FERNANDA		FACILITY TYPE:	840
ADDRESS:	29292 CROWN VALLEY PKWY		TELEPHONE:	(949) 831-4272
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 0	DATE:	10/31/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maria Walters, Director		TIME COMPLETED:	01:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Mila Quinto conducted a case management inspection of the facility for the purpose of the facility increasing their capacity from 120 school age children to 200 school age children. Currently, the facility is licensed for 120 children in rooms B1, B4, B6, Library (D1), D3, D5, D6, K1, K2, and PAC. Hours of operations are: Monday, Tuesday, Thursday, and Friday; 7am.-8:00 a.m. and 3:00p.m.-5:30p.m., and Wednesday; 7am-8am and 12:30pm -5:30 pm, Holiday and Summer Breaks operation hours are: 8am.-5pm; serving children ages 4.9-14 years old. LPA met with the director, Maria Walters who gave LPA a tour of the facility. The classrooms are located inside the Community Roots Academy. The school is owned by the Capistrano Unified School District. There were no children in care during the inspection visit. A review of the Facility Personnel Report Summary 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. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the director’s office. The children will use the bathroom, located next to the director’s office. Medication is stored in the director’s office in a locked cabinet. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability and good repair. Drinking water is available indoor/outdoor by the children bringing their own water bottles from home, labeled with their names. If children need to re-fill their bottles, there is a water dispenser available. The facility provides PM snacks only. Page 1 of 3

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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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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: COMMUNITY CARE CLUB @ COMMUNITY ROOTS ACADEMY	FACILITY NUMBER: 304371120
	VISIT DATE: 10/31/2023

NARRATIVE

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First Aid supplies were inventoried. Sign in / sign out record meets regulation requirements.

Last fire clearance approval letter was on 08/10/2021.

This school age childcare program meets the requirements of Health and Safety Code Section 1596.806 and is exempt from square footage requirements for indoor, and outdoor activity space. The facility is also exempt from fencing, outdoor activity space, toilet, and isolation space requirements. The capacity per room for a school age childcare program that meets the requirements of Health and Safety Code Section 1596.806 shall not exceed the number of children for which a room of this size is commonly approved for school use during the school day.

The facility has access to all the restrooms on the campus because elementary children are not present during the operation of school age program.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.ed by a school-age childcare program.

The Director, Maria Walters was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: COMMUNITY CARE CLUB @ COMMUNITY ROOTS ACADEMY	FACILITY NUMBER: 304371120
	VISIT DATE: 10/31/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the director, Maria Walters.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

The request of the facility to increase the capacity from 120 to 200 children in rooms B1, B4, B6, Library (D1), D3, D5, D6, K1, K2, and PAC will be final reviewed and discussed with management in the Regional Office. The facility will be notified if any additional information is required.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC809 (FAS) - (06/04)

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