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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600220
Report Date: 10/08/2019
Date Signed: 10/08/2019 12:01:56 PM

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:LAGUNA PRESBYTERIAN PRESCHOOLFACILITY NUMBER:
300600220
ADMINISTRATOR:HERZOG, ANNEFACILITY TYPE:
850
ADDRESS:415 FOREST AVENUETELEPHONE:
(949) 494-0504
CITY:LAGUNA BEACHSTATE: CAZIP CODE:
92651
CAPACITY:105CENSUS: 41DATE:
10/08/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director, Anne HerzogTIME COMPLETED:
12:45 PM
NARRATIVE
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An unannounced Random/Annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Nguyen. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Operating hours are 7:30am to 5:30pm, Mon-Fri. Upon arrival LPA met with, Director, Anne Herzog. LPA observed 41 preschool age children with 8 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

The facility was toured inside and outside, and the floor and yard plan were verified. The facility representative stated there is no bodies of water onsite. LPA confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly. The items which could pose a danger to children (disinfectants and cleaning solutions) were stored out of the reach of children. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. LPA observed a children’s Benadryl expired 7/2019. The children’s bathrooms were observed to be in safe and sanitary operating conditions.

All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Food is not prepared on site, snacks and lunches are provided by parents. Solid waste receptacles have a tight-fitting cover and are in good repair. Children nap on mats, and bedding is sent home weekly to be laundered by parents. There is drinking water available to children both indoors and outdoors. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher that meet statutory requirements.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
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 4
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: LAGUNA PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 300600220
VISIT DATE: 10/08/2019
NARRATIVE
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Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.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.

Based on LPA observations and record reviews, the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101226 (e)(2) and Health and Safety code 1596.8662 (b)(1) . Please refer to attached 809D for documentation of deficiency.

Exit interview was conducted with Assistant Director, Alexandra Rowley. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The director/licensee was provided a copy of their appeal rights (LIC 9058 12/16) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years.


SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LAGUNA PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 300600220
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2019
Section Cited

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1596.8662(b)(1) Mandated Reporter Training. A person who, on January 1, 2018, is a licensed child care provider beginning the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
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Based on interview and record reviews, three of the staff do not have the mandated reporter training certificates. This poses a potential Health and Safety risk to the children in care.
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Type B
10/31/2019
Section Cited

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101226 Health-Related Services (e) In centers where the licensee chooses to handle medications: (2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated. This requirement was not met as evidenced by:
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Based on observations of written expiration dates of 7/2019 on one of the children's Benadryl bottle. The facility failed to meet the regulations for the above section. This is a potential risk to the health and safety of 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: LAGUNA PRESBYTERIAN PRESCHOOL
FACILITY NUMBER: 300600220
VISIT DATE: 10/08/2019
NARRATIVE
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The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. The facility has conducted an emergency drill within the past six months.

Sign in/out procedure was reviewed for compliance. The child is signed in and out for the person responsible for the child. A random sample of ten children's files were reviewed for an admission agreement and found to be in substantial compliance.

Staff files for staff present during today’s inspection were reviewed for appropriate documentation of education credits. At least one staff member present possesses current CPR/First Aid certifications, which expires 5/2020. Proof of immunization's against influenza (or written decline), pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. Proof of completion as required by AB 1207 was observed in staff files expect for 3 staff.

This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, 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. 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

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.


English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4