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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371227
Report Date: 08/19/2021
Date Signed: 08/19/2021 11:17:17 AM

Document Has Been Signed on 08/19/2021 11:17 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:LADERA RANCH ELEMENTARY SCHOOLFACILITY NUMBER:
304371227
ADMINISTRATOR:GHADA JURDIFACILITY TYPE:
850
ADDRESS:29551 SIENNA PARKWAYTELEPHONE:
(949) 234-5341
CITY:LADERA RANCHSTATE: CAZIP CODE:
92694
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 11DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Site supervisorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA),Mahnaz (Nancy) Malek conducted an on site inspection for the purpose of an Annual Required- 1 year. The Covid-19 Emergency Response questionnaire was reviewed and answered by the site supervisor, Jurdi Ghada before entering the facility. LPA toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken. Due to Covid-19 guidelines, LPA observed staff and children were following CDC and Dept of Public Health Guidelines. The overall census observed was 2 preschool staff and 11 preschool children on the playground. It was also observed 10 preschool children with 6 adults from the Special Education Program were main-streaming with children of room # 104. (A waiver has requested for this purpose). Room # 104 was inspected. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. 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. (The staff are exempt from this requirements because they are employees of Capistrano Unified School District. This program is operating in two sessions. Morning session from 8:00 am to 11:00 am and afternoon session from 12:00 noon to 3:00 pm. LPA provided Guardian Information and website info:https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Snacks and lunches are provided by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by children's water bottles. The children's bathrooms are clean and sanitary. Children do not nap since the program is a part time program.` The facility has conducted against Continued on page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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: LADERA RANCH ELEMENTARY SCHOOL
FACILITY NUMBER: 304371227
VISIT DATE: 08/19/2021
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an emergency drill within the past six months. The facility has a working carbon monoxide detector. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility. Staff files were reviewed for staff present during the facility inspection this date. Two staff files were reviewed. Health screening and immunizations as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization pertussis, measles for staff were reviewed and within compliance. Beginning March 31, 2018, H&S Code
1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications. Among reviewed files, one staff has current certificate.
Ms. Ghada was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. She was also informed that the LIC 508 must be submitted with all Criminal Background Clearance, and an ID card.
Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of (5) of children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.
LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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
The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at
least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. Continued on page 3
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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: LADERA RANCH ELEMENTARY SCHOOL
FACILITY NUMBER: 304371227
VISIT DATE: 08/19/2021
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The cushioning material produced for the purpose around the climbing equipment, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by children's water bottles. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.
Ms. Ghada was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov The facility has been added to email list to receive Quarterly Update from the Department.
Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The director was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative. A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility. English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at this inspection date.. An exit interview was completed with director. 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 director 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.
Documents/Information to be updated and returned to the Licensing Office:

LIC 200A updating the hours of operation. The license states 8:00 am to 11:30 am.

Report ends here.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
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