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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371286
Report Date: 08/13/2021
Date Signed: 08/13/2021 04:06:03 PM

Document Has Been Signed on 08/13/2021 04:06 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ENCHANTED CASTLE PINE TREE MONTESSORI SCHOOLFACILITY NUMBER:
304371286
ADMINISTRATOR:MADAN,P. & ZAVALA-BENITEZ,FACILITY TYPE:
850
ADDRESS:17102 MARDA AVENUETELEPHONE:
(714) 996-7463
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 56TOTAL ENROLLED CHILDREN: 0CENSUS: 29DATE:
08/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Perla Zavala-Benitez, DirectorTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analysts (LPA), Nguyen Tran and Mila Quinto conducted an onsite inspection for the purpose of a Required - 1 Year visit. LPAs and Director Perla Zavala-Benitez toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 6 preschool staff and 29 preschool children. Due to COVID 19 guidelines, LPA observed staff and children following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:30a.m.- 5:30p.m., Monday through Friday. 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.

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. Food is prepared on site; lunch and snacks are provided. Food prep areas were clean and sanitary. Food is properly stored. Menus were posted where they could be reviewed 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 Brita filtered drinking fountain, and bottle with the child’s name on it. The children's bathrooms are clean and sanitary. Children nap on cots/mats, and bedding is stored individually and is taken home weekly to be washed by parents or facility washes blankets at end of week. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector and fire extinguisher. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ENCHANTED CASTLE PINE TREE MONTESSORI SCHOOL
FACILITY NUMBER: 304371286
VISIT DATE: 08/13/2021
NARRATIVE
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Page 2 of Report.
Staff files were reviewed for staff present during the facility inspection on this date, 6 staff files were reviewed. Health screening and immunization records as required were reviewed and 1 of 6 staff member did not have the health screening. 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 against pertussis, measles for (licensee and assistant) 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. The 3 of 6 staffs' files were missing current Mandated Reporter Training certificates. Per AB1207, new staff have 90 days to complete the training from date of hire. The 2 of 3 staff were hired within 90 days. However 1 of 3 staff had an expired mandated reporter training certificate. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 12/31/2022.

Children's records were reviewed, and there was a separate, complete and current record for each child. LPA observed zero children from 0-12 months. 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.

Incidental Medical Services (IMS) policy was discussed. 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. 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. The grass appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by
bottles with the child’s name on it. 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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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: ENCHANTED CASTLE PINE TREE MONTESSORI SCHOOL
FACILITY NUMBER: 304371286
VISIT DATE: 08/13/2021
NARRATIVE
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Page 3 of Report

The Director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov, Director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

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 Planhas 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. Facility Director does not have lead training Certificate.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the Director.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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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: ENCHANTED CASTLE PINE TREE MONTESSORI SCHOOL
FACILITY NUMBER: 304371286
VISIT DATE: 08/13/2021
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Page 4 of Report.

Based on LPAs observations, record reviews and interviews, the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section HSC 1596.8662 (4)(b)(1) and 101217(a)(11) Personel Records on the attached LIC 809D.

An Inspection and 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. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

The facility representative 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.


SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/13/2021 04:06 PM - It Cannot Be Edited


Created By: Nguyen K Tran On 08/13/2021 at 03:25 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: ENCHANTED CASTLE PINE TREE MONTESSORI SCHOOL
FACILITY NUMBER: 304371286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
HSC
1596.8662(4)(b)(1)

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1596.8662(4)(b)(1) ... licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training and shall complete renewal mandated reporter training every two years.

This requirement is not met evidenced by:
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Director will submit staff's Mandated Reporter Training by 08/27/21.
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Based on record review and interviews, one of the staff has a Mandated Reporter training certification that expired on 03/2021, which posts a potential safety risk to children in care.
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Type B
08/13/2021
Section Cited
CCR101217(a)(11)

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101217(a)(11) Personel Records
The licensee shall ensure that personnel records ... contain the following ...A health screening as specified in Section 101216(g).

This requirement is not met evidenced by:
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Director will submit staff's Health Screening form LIC 503 by 08/27/21.
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Based on record review and interviews, one of the staff's file did not have a Health Screening LIC 503, which posts a potential health risk to 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:Thuy Ho
LICENSING EVALUATOR NAME:Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2021


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