304371247-9-12-2023-06-CC-ABOI-CVLQSB-20230912122516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371247
Report Date: 09/12/2023
Date Signed: 09/12/2023 12:25:31 PM

Document Has Been Signed on 09/12/2023 12:25 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	MILESTONES MONTESSORI OF LAKE FOREST		FACILITY NUMBER:	304371247
ADMINISTRATOR:	PATOPOFF, JAMIE		FACILITY TYPE:	850
ADDRESS:	23222 LAKE CENTER DRIVE		TELEPHONE:	(949) 830-9999
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY: 189	TOTAL ENROLLED CHILDREN: 189	CENSUS: 43	DATE:	09/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	PATOPOFF, JAMIE		TIME COMPLETED:	12:45 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	On 09/12/2023 Licensing Program Analyst (LPA), A. Bootorabi conducted an on site visit for the purpose of a 1 year required inspection. LPA and Jamie Patopoff toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Upon arrival, an Entrance Checklist (LIC 125) was provided to Jamie P. Director/Teacher. Census was taken: Orange Room: 12 Students / 2 Teachers Red Room: 17 students / 2 teachers - Yellow 17 students and 2 teachers. During the inspection, it was determined the facility is operating within its licensed capacity and within compliance with staffing ratios. Facility hours were confirmed with the director J.P. The director confirmed hours are 7 a.m.- 6 p.m., Monday through Friday. The LPA and director toured the facility inside and outside. The facility sketch (LIC 999) was verified. Areas stated to be off-limits by the facility sketch were made off-limits by means of closed doors, and gates in the playground that separate the different age group playgrounds. Documents reviewed and to be posted in a prominent, publicly accessible area at the facility: Facility License, Menus, LIC 613A Personal Rights, PUB 269, PUB 393 Notification of Parent Rights, and LIC 610 Emergency Disaster Plan. Documents were posted by the front entrance in different locations but are visible to the public. The facility does not have menus due to the children bringing their lunches from home. Page 1

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MILESTONES MONTESSORI OF LAKE FOREST	FACILITY NUMBER: 304371247
	VISIT DATE: 09/12/2023

NARRATIVE

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Documents to be reviewed during inspection: Verification of Disaster and Fire Drill, Daily Activity Schedule, Sign In/Out Sheets, and LIC 9148 Earthquake Preparedness. The facility had 4 of 4 documents available for review.
The last Fire Drill was conducted on August . The daily activity schedule was posted by the classrooms and a curriculum was available for review by the front entrance.

SIGN IN AND SIGN OUT
The facility is currently using and electronic application to sign in/out. The LPA observed the sign-in procedure consisting of parents using a code to sign in and out their children. The director stated that if a parent is not picking up and a designated adult is they use paper sign in and out forms.

The facility’s sign-in and out procedure does include: The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. (b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

Classrooms 3 - 3 were toured with the director. Classrooms 3 of 3 were inspected and the activity space, and items that could pose a danger to children (detergents and cleaning compounds) were observed to be stored out of the reach of children. Medication is stored in emergency kit backpacks. In classroom red the backpack was observed in the bathroom within reach of children if they were in the classroom and in classroom orange the backpack was observed on the floor and would be accessible to children if they were in the classroom. A consultation was provided and the director stored the medication in a magnetic locked cabinet during the visit.

NAPPING EQUIPMENT: Mats are used for napping were observed to be maintained in a safe condition. The facility was reminded that napping equipment shall be arranged so that each child has access to a walkway

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MILESTONES MONTESSORI OF LAKE FOREST	FACILITY NUMBER: 304371247
	VISIT DATE: 09/12/2023

NARRATIVE

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without having to walk on or over the cots or mats of other children. Bedding shall not be shared by different children without first laundering the bedding. Bedding shall be individually stored so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding.

DRINKING WATER
Drinking water was observed and readily available to children in both indoor and outdoor activity areas.

FOOD SERVICES
The facility does not provide meals to children. Children bring their meals from home. It was state by the director that if a parent forgets to bring a lunch they contact them and the parent makes arrangements to provide an adequate meal for the child.

IDENTIFICATION AND LOCATION OF MEDICATION STORED IN THE FACILITY
The LPA observed medication being stored in the classroom for each child that needs it in the emergency backpack. The LPA reviewed the record of current medications, including the name of the prescribing physician, and instructions in classroom RED.

Incidental Medical Services (IMS) - Child Care Centers
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. 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 the publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

CARBON MONOXIDE – SMOKE DETECTOR – FIRE EXTINGUISHER
A functioning carbon monoxide detector and smoke alarm were observed. The director stated that the smoke and carbon monoxide tester were combined and recently check by the fire department. A fire extinguisher was observed in the podium and in classroom red,orange, and yellow.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MILESTONES MONTESSORI OF LAKE FOREST	FACILITY NUMBER: 304371247
	VISIT DATE: 09/12/2023

NARRATIVE

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OUTDOOR ACTIVITY SPACE
The surface of the outdoor activity space was observed to be maintained in a safe condition for activities. The surface of the outdoor activity space was observed to be free of hazards including, but not limited to, holes, broken glass, and other debris.

The cushioning material used underneath the climbing structure in the outdoor space for preschool age children consists of artificial grass and cushion like material underneath on fall areas. The outdoor equipment and toys were in good repair and were free of sharp edges. There are no bodies of water present at the facility. The facility’s outdoor grounds are safe, sanitary, and in good repair. LPA observed a boat structure that is not elevated high and accessible to children, two climbing structures, and a pretend kitchen

PERSONNEL RECORDS
The LPA requested to review staff records of adults working directly with children. The following documents were requested for review exemptions or exemptions, Staff Qualifications, Immunization Records, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to report Child Abuse, 1 CPR First Aid Certification of staff present at the facility at all times, TB clearance, and a Mandated Reporter Training Certificate.
The facility had one separate file for each staff member. The files reviewed during today’s visit were observed to be completed. All staff had current Mandated Reporter Training.

Children’s Records Reviewed
The LPA requested complete children’s records of 4 children enrolled in the program. Children's records were reviewed, and there was a separate, complete, and current record for each child. The LPA reviewed files to verify the following documents Immunization Records, LIC 700 Identification, Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. The children’s records were complete currently.

myChildCarePlan.org
The facility representative was informed of the www.MyChildCarePlan.org website; 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.
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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MILESTONES MONTESSORI OF LAKE FOREST	FACILITY NUMBER: 304371247
	VISIT DATE: 09/12/2023

NARRATIVE

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CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA obtained Certificate of occupancy City of Lake Forest Building & Safety Division and director stated the building was constructed after 2010.

The facility met the California Code of Regulations, Title 22 Division 12 during today’s visit and no citations were provided.
Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name).

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 at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

End of Report

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC809 (FAS) - (06/04)

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