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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606414
Report Date: 12/11/2019
Date Signed: 12/11/2019 02:46:25 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:LA PURISIMA SCHOOLFACILITY NUMBER:
300606414
ADMINISTRATOR:CLARK, RENEEFACILITY TYPE:
850
ADDRESS:18801 SPRING STREETTELEPHONE:
(714) 633-5411
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:50CENSUS: 34DATE:
12/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Renee Clark (Director) & Sandra Ramirez (Office staff) & Rosa Ramirez (school principal) TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Jungmi Han conducted an onsite inspection for the purpose of an Annual Random. LPA met office assistance, Sandra Ramirez and director, Renee Clark. Director was supervising 14 preschool children with staff#1 at the playground. LPA toured the facility inside and outside while director was supervising children with staff#1. Director stated room P2 is not under community care licensing program since approximately year 2011. LPA Han observed room P2 is using by transitional kindergarten children who are 4 – 5 years old age range. Rosa Ramirez, school principal and Sandra Ramirez, Office assistance stated room P2 is under La Purisima School license. LPA Han verified La Purisima school has private school license for grade K through 8th grade at department of education website. For licensing requirement, room P1 and P2 are designated for 2 through 6 years old age children. The facility failed to report to remove P2 from license. For child care licensing requirement purpose, LPA inspected room P2 and reviewed staff files in room P2.

Census was taken in individual classrooms. The room P1 census observed was 2 preschool staff and 14 preschool children and room P2 census observed was 2 transitional kindergarten staff and 20 transitional kindergarten children. Staff #4, Jocelyn Rivera in room P2 was not on the facility personnel report summary on this date. All other 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 such as 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; snacks are provided. Children brings their own lunch. Director stated she offers 2% milk for preschool children. 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.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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 7
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: LA PURISIMA SCHOOL
FACILITY NUMBER: 300606414
VISIT DATE: 12/11/2019
NARRATIVE
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There is drinking water available to children indoors by drinking fountain and sprits bottles with the child’s name on it. The children's bathrooms are clean and sanitary. Children nap on cots and bedding is stored individually and is taken home weekly to be washed by parents. 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 not posted by the entrance of the facility

Staff files were reviewed for staff present during the facility inspection this date. 4 out of 4 staff files were reviewed. Staff#4 did not have Health screening and all Immunizations as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for 4 out of 4 staff were reviewed and all 4 staff did not have Measles immunization record at the facility upon request. 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. 4 out of 4 staff did not complete mandated reporting training. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 8/2021. The director was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. Director was also informed that the LIC 508 must be submitted with all Criminal Background Clearance.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 9 out of 14 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. LPA observed 8 out of 22 parents or legal guardians in P2 room did not sign in/out with their full legal signatures between December 1 and 11. LPA reviewed current children's roster provided by Sandra Ramirez, office assistance . The current children's roster doesn't include child's birthday, physician's name and phone number, date enrolled and date left.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: LA PURISIMA SCHOOL
FACILITY NUMBER: 300606414
VISIT DATE: 12/11/2019
NARRATIVE
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This facility provides Incidental Medical Services - (IMS). LPA reviewed storage of medication and 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. 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
cushioning material rubber mats commercially produced for the purpose around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by drinking fountain. 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.
Inspection and report reviewed and exit interview was conducted in English. 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 at www.ccld.ca.gov
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 Plan has 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.
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
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: LA PURISIMA SCHOOL
FACILITY NUMBER: 300606414
VISIT DATE: 12/11/2019
NARRATIVE
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· 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
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 101229.1(a)(1), 101170 (e)(1), 101216.3 (b), and Health and Safety 1597.622. (a) (1),1596.8662 (b) (1) are being cited on the attached LIC 809D.
An exit interview was completed with school principal. 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. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. 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.
Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Designation of Administrative Responsibility (LIC 308)
- Updated Plan of Operation
- Updated Daily Activity Schedule
End of Report
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: LA PURISIMA SCHOOL
FACILITY NUMBER: 300606414
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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1597.622. (a) (1) Commencing September 1, 2016, 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...influenza vaccination ... each year. This requirements is not met as evidenced by:
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Based on record review and interview with staff, the director failed to ensure to keep 4 out of 4 staff's measles immunization records in the facility staff file. This poses a potential health
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Type B
01/10/2020
Section Cited

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1596.8662 (b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee... every two years following the date on which ...initial mandated reporter training. This requirements is not met as evidenced by:
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Based on record review and interview with staff, the director failed to ensure to complete mandated reporter training for all 4 staff at the facility.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: LA PURISIMA SCHOOL
FACILITY NUMBER: 300606414
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2019
Section Cited

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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance...This requirement is not met as evidenced by:
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Based on record review and interview, Jocelyn Rivera worked at the facility without criminal clearance since 9/2018. The director failed to obtain a california clearance. This poses an immediate Health and Safety risk to the children in care.
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Civil penalty has been issued
Type A
12/12/2019
Section Cited

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101216.3 (b)Teacher-Child Ratio (b)The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. This requirement is not met as evidenced by:
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Based on LPA observation and staff qualification reivew in room P2 at 9:50AM, there are 20 children (4-5 years old) with a fully qualified teacher and an assistance who doesn't have any ECE units. This poses an immediate Health and Safety risk to the 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: LA PURISIMA SCHOOL
FACILITY NUMBER: 300606414
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited

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101229.1(a)(1)Sign In and Sign Out (a)...the licensee shall develop, maintain, and implement ...child in/out of the child care center...(1)The person who signs the child in/out shall use his/her full legal signature ...record the time of day. This requirement is not met as evidenced by:
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Based on observation and record review, LPA observed 8 out of 22 parents did not signed in/out with full legal signature between Dec. 1 and Dec. 10. This poses a potential Safety risk to the 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2019
LIC809 (FAS) - (06/04)
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