300610655-12-16-2019-06-CC-GCOY-BJX2KR-20191216162822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300610655
Report Date: 12/16/2019
Date Signed: 12/16/2019 04:28:32 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:	PACIFIC PRESCHOOL		FACILITY NUMBER:	300610655
ADMINISTRATOR:	WAY, LYNDA		FACILITY TYPE:	850
ADDRESS:	31341 NIGUEL ROAD, SUITE H		TELEPHONE:	(949) 248-8711
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	115	CENSUS: 32	DATE:	12/16/2019
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Director: Kathleen Rudner		TIME COMPLETED:	04:40 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An Annual/Required 3 years inspection was conducted on this date by Licensing Program Analyst (LPA) Connolly. Upon arrival LPA met with acting director Kathleen Rudner who accompanied the LPA on a tour of the facility inside and outside. LPA observed 29 preschool children with 7 staff and 3 children in the toddler option program with 1 staff. A review of criminal clearance records on this date indicates adults who require caregiver background checks have received criminal record and child abuse index clearances. Operating hours remain Monday through Friday 7 AM to 6 PM in rooms 1, 3, 4, 5, 6 and 7. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. LPA inspected the following areas: availability of drinking water within the classrooms, safe & sanitary sinks and toilets, water temperature, toilet paper, paper towels. Furniture, toys, floors and other equipment were inspected for cleanliness, safety and age appropriateness. Food preparation areas were inspected for cleanliness and proper storage of cleaning solutions, free of rodents and other vermin. Menus are posted. Lunch is brought from home. AM and PM snacks are provided by the facility. Menus reflect snacks are provided from more than one food group. The preschool and toddler option outdoor play yards were toured. The outdoor play equipment was inspected for safety, good repair, free from sharp, loose or pointed parts and age appropriateness. The cushioning material was inspected for being sufficiently placed underneath climbing structures and play equipment to absorb falls. There was availability of drinking water and required shade. There are no bodies of water. Continued on page two

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PACIFIC PRESCHOOL	FACILITY NUMBER: 300610655
	VISIT DATE: 12/16/2019

NARRATIVE

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The sign in and out sheets were reviewed. Staff and children files were reviewed. LPA observed Health Screenings and verification of CPR/First Aid. At least one staff member present possessed current CPR/First Aid certifications, which expire10/2020. Staff’s required immunization (MMR, TDAP, FLU) and Mandated Reporter training certificates were available for review.

Incidental medical services were discussed as this facility cares for children who need incidental medical services. LPA reviewed storage of medication and equipment/supplies and reviewed children’s personnel and administrative records.

The director provided a copy of the current personnel report (LIC 500) , updated emergency plan (LIC 610) and current designation of facility responsibility (LIC 308). LPA provided a copy of Lead Poisoning Facts. The director was informed that any proposed changes to the physical plant, including telephone number, shall be immediately reported to the licensing office.

In the areas that were evaluated no deficiencies were observed of the California Code of Regulation, Title 22, and Division 12 at the time of the inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed.
The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

Notice of Site Visit was posted adjacent to the door. Notice of Site Visit needs to be posted for 30 consecutive days.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

LIC809 (FAS) - (06/04)

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