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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371483
Report Date: 12/19/2022
Date Signed: 12/20/2022 10:53:07 AM

Document Has Been Signed on 12/20/2022 10:53 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:FAIRMONT SCHOOLS SAN JUAN CAPISTRANOFACILITY NUMBER:
304371483
ADMINISTRATOR:HARRY TOLLIVERFACILITY TYPE:
850
ADDRESS:26333 OSO ROADTELEPHONE:
(949) 443-4050
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 132TOTAL ENROLLED CHILDREN: 132CENSUS: 0DATE:
12/19/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sarah Escobar , Director TIME COMPLETED:
11:45 AM
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An unannounced case management Director initiated inspection for a newly remodeled preschool playground was conducted on this day by Licensing Program Analysts (LPAs) Patricia Duron and Dianna Valdez Santana. LPAs observed 0 children and 1 staff members during today's inspection. The purpose for today's inspection was to measure and inspect the new play structure and new flooring.

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 following was observed:
The yard was clear of hazardous items
Playground is enclosed by appropriate fence.
Adequate shade is provided by trellis
Play structure is age appropriate for ages 2 - 5 years old.
Rubber mulch flooring for playgrounds under and around play structure

No deficiency was observed during today's inspection. Exit interview was conducted and a copy of this report was provided to the facility representative on this date. Appeal Rights were reviewed and provided to Director. 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: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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