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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603559
Report Date: 05/09/2022
Date Signed: 05/09/2022 01:02:46 PM


Document Has Been Signed on 05/09/2022 01:02 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:ST. MARGARET'S SCHOOLFACILITY NUMBER:
300603559
ADMINISTRATOR:LOZON, CRISELDAFACILITY TYPE:
850
ADDRESS:31641 LA NOVIATELEPHONE:
(949) 661-0108
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:96CENSUS: 65DATE:
05/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:DirectorTIME COMPLETED:
01:30 PM
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On 5/9/2022 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management of the facility for an incident which was self reported by the facility representative to our office on 5/4/2022.
LPA met with director, Criselda (Cris) Lozon. The Covid-19 Emergency Response questionnaire was reviewed and answered. LPA and the director toured the facility inside and outside. There were a total of 65 preschool children and 15 staff were present at the facility. 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. Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
According to the report sent to our office, a 4 year old child fell from a mud bench which was located on the sand/mud area on the playground. Child hit his head and got a cut on the left side of forehead above the child's eyebrow.
Today LPA discussed the incident with the director. She showed the mud bench which the child was on it. The director stated they removed the bench from the sand area to prevent any future injuries. LPA inspected the sand/mud area and was free from any hazardous. Child has returned to school. LPA attempted to interview the 4 year old child today. Child did not disclose any details to LPA. LPA interviewed the witness staff. She stated there were a total of six children on the playground. 3 children were in the sand area making creative objects. Child was on the bench leaning towards the ground while child lost his balance, fell and hit one of the pottery plants on the side of the sand area. The bench is removed. According to witness staff, this incident happened in front of the staff so quickly. LPA found out this incident was not due to lack of supervision.
A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director, Criselda (Cris) Lozon)
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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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