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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371651
Report Date: 12/01/2023
Date Signed: 12/01/2023 04:28:02 PM

Document Has Been Signed on 12/01/2023 04:28 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:TRF ST. PETERFACILITY NUMBER:
304371651
ADMINISTRATOR:MEJICO, DANETTEFACILITY TYPE:
830
ADDRESS:1510 NORTH PARTONTELEPHONE:
(310) 420-1025
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY: 9TOTAL ENROLLED CHILDREN: 9CENSUS: 0DATE:
12/01/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Renee Jacobs and Danette MejicoTIME COMPLETED:
04:45 PM
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On 12/01/2023, Licensing Program Analyst (LPA), Mila Quinto and Licensing Program Manager (LPM), Monica Cuddy conducted an announced Pre-Licensing inspection for a new license. Upon arrival, LPA met with Applicant, Renee Jacobs and Director, Danette Mejico. Applicant is requesting to be licensed for 9 infants ages 0 months to 2 years old in classroom 1-A. The hours of operation will be Monday thru Friday, 7:30am – 6:00pm.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Renee Jacobs that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Renee Jacobs stated that they will be in a higher cabinet located in the office. A fully equipped first aid kit is located in the back room. There is an operational carbon monoxide detector on site. All required licensing documents were observed posted in the lobby area. Children will be signed in and out at classroom entrance.

Total indoor activity space measured at 262.76 square footage and can accommodate a capacity of 7 infant children. Sides of the changing table are at least 3” high and the changing table is within arm’s reach of a sink. Applicant will provide proof of 1” padding for the changing table. Diapering sink is not used for meal preparation or dishwashing. Applicant stated will use the kitchen sink for food preparation. Cribs meet regulatory requirements. Crib area is separated from activity space by a plastic divider. This barrier is at least four feet high, made of sound absorbing material and allows for supervision of napping children. Sleep logs are kept in the crib area. Needs and Services Plans and Sleep Plans are kept in infant classroom. LPA observed exposed wire in the crib area. Page 1 of 5

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: TRF ST. PETER
FACILITY NUMBER: 304371651
VISIT DATE: 12/01/2023
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Page 2 of 5

There is no restroom for the infant children; however, applicant will provide at least one potty chair for every five infants. LPA observed a total of 1 sink available for children’s use. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the office and staff restroom.

Facility will provide breakfast, lunch and snacks through the Santa Unified School District.

The facility currently has a fully fenced playground area which is separate from other components. Fencing is made of wrought iron and is at least four feet high. The total square footage for all the outdoor activity space is 546.88 square feet, which can accommodate 7 infant children. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a climbing structure on the playground; however, there was no manufacturer’s sticker/manual to verify the age appropriateness. There is adequate cushioning in fall zones of climber provided by artificial grass. Drinking water is available by igloo coolers. LPA observed 2 air conditioning extending out the building that is 3 feet above the ground. The applicant stated will install corner protector around the air conditioner to prevent children from harm. Applicant, Renee Jacobs was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: TRF ST. PETER
FACILITY NUMBER: 304371651
VISIT DATE: 12/01/2023
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The following corrections are needed from applicant, Renee Jacobs prior to the issuance of the license:

1) Health Screening Report (LIC503) Negative TB test results, and proof of immunity against measles, pertussis, and influenza (or provide a statement declining the influenza vaccine).
2) Changing tables have at least 1” padding covered with moisture-resistant, washable material.
3) Repair the exposed wire located in the crib area.
4) Cubbies for the infant children served.
5) At least one potty chair for every 5 infants served.
6) Provide proof of the climbing structure on the playground is age appropriate for the ages served.
7) Installation of corner protector for the 2 air conditioner located in the infant playground.

Applicant, Renee Jacobs understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

Applicant 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: TRF ST. PETER
FACILITY NUMBER: 304371651
VISIT DATE: 12/01/2023
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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.

LPA reviewed with applicant the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.”

Applicant 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. “



Exit interview conducted and report was reviewed with the director, Danette Mejico.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: TRF ST. PETER
FACILITY NUMBER: 304371651
VISIT DATE: 12/01/2023
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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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5