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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610625
Report Date: 11/15/2023
Date Signed: 11/15/2023 01:34:19 PM


Document Has Been Signed on 11/15/2023 01:34 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:SILVERADO MODJESKA CHILDRENS CENTERFACILITY NUMBER:
300610625
ADMINISTRATOR:BRIGGS, LAURIEFACILITY TYPE:
850
ADDRESS:7525 SANTIAGO CANYON ROADTELEPHONE:
(714) 649-2214
CITY:SILVERADOSTATE: CAZIP CODE:
92676
CAPACITY:62CENSUS: 21DATE:
11/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:BRIGGS, LAURIETIME COMPLETED:
01:50 PM
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LPA Bootorabi is conducting a case management visit today. LPA Bootorabi met with Laurie Briggs.

Upon departure of the LPA's visit LPA observed one child (C1) standing in front of the playground gate for the Acorn Classroom without any teacher supervision. The child was directed into the playground by a staff #1 (S1) and the child proceeded to go into the playground with Staff #2 that was inside the playground with 9 other children. Staff #3 & #4 were inside the classroom with 5 children that were getting ready to transition into the acorns playground.

A consultation was provided regarding staff files being updated and a LIC 126 was provided to the director. The director also received a copy of LIC 311A.

A copy of CDPH 286 (11/22) was also provided during today's visit

Copies of Teacher Child Ratio 101516.5, Teacher Aide Qualifications and Duties 101216.2, 101230 Activities were provided to the director.

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 director was reminded that all adults 18 and over, 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.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SILVERADO MODJESKA CHILDRENS CENTER
FACILITY NUMBER: 300610625
VISIT DATE: 11/15/2023
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The facility did not meet the California Code of Regulations, Title 22 Division 12, and regulations not met were observed, discussed, and cited at the time of the visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today:
101229(a)(1) Responsibility for Providing Care and Supervision

Due to the Type A violations cited today, 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 them to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt of the Proof of Correction for 30 consecutive days.


Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the director BRIGGS, LAURIE.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 11/15/2023 01:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: SILVERADO MODJESKA CHILDRENS CENTER
FACILITY NUMBER: 300610625

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision(1) No child(ren) shall be left without the supervision of a teacher at any time.. based on LPA's observations C1 was left outside between the acorns room and playground without any teacher
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The director stated that she will be reminding the teachers to communicate with their walkie talkies during transitions to avoid lack of communication. The director will be having a all staff meeting today and provide a agenda and sign in sheet to LPA regarding the meeting via email.
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supervision during the classrooms transition back into the playground which poses an immediate health & safety risk to 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: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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