300610674-10-25-2021-06-CC-STOE-C85PNB-20211025112741

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300610674
Report Date: 10/25/2021
Date Signed: 10/25/2021 11:28:00 AM

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:	CAPISTRANO U.S.D/LAS PALMAS STATE PRESCHOOL		FACILITY NUMBER:	300610674
ADMINISTRATOR:	VARGAS, ESTRELLA		FACILITY TYPE:	850
ADDRESS:	1101 CALLE PUENTE, #13		TELEPHONE:	(949) 492-3456
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92672
CAPACITY:	48	CENSUS: 21	DATE:	10/25/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Lauren Pattullo		TIME COMPLETED:	11:45 AM

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 unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence for the purpose of adding a room. The facility has requested to add classroom 14 to their license. The facility is currently licensed for classrooms 13 and 39 only. The facility is requesting to move the classroom currently in classroom 39 to classroom 14. The facility is currently licensed for 48 children and is not requesting a capacity change. The facility is located on the Las Palmas Elementary School campus and is a state preschool. LPA Torrence met with Lauren Pattullo, Director of Early Childhood General and Special Education Programs, who guided analyst on a tour of the facility. Ms. Lauren left the inspection around 10:45 a.m. LPA completed the inspection with Site Supervisor, Estrella Vargas. LPA observed 21 children playing outside. Operations hours are Monday-Friday; an AM session: 8:00 a.m.-11:00 a.m. and PM session: 12:00 p.m.-3:00 p.m., serving children ages 3-5 years old. Waiver on file to share elementary school's restrooms. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions (Employees are staff of the Capistrano Unified School District). All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the front office, where there is either an LVN present. The bathroom in the health office will be used for the ill children. Medication will be stored in each classroom, in a locked cabinet, in a locked safety box. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. Children bring their own water bottles from home and the school provide water, if needed. Children are able to refill in classroom by a water dispenser. First Aid supplies were inventoried. Sign in / sign out record meets regulation requirements. School provides free meals for all the students. Facility pick up the food at the cafeteria, located on campus. Continue on next page (1 of 2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021

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: CAPISTRANO U.S.D/LAS PALMAS STATE PRESCHOOL	FACILITY NUMBER: 300610674
	VISIT DATE: 10/25/2021

NARRATIVE

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Indoor Activity Space Measurements:
Classroom #13: 31.04 x 29.01 = 900 sqft.
Classroom #14: 31.04 x 29.01 = 900 sqft. -Added Classroom
Total= 1,800 sqft. divided by 35 = 51 children

Total children toilets and sinks:
Toilets: 9 x 15 = 135 children
Sinks: 6 x 15 = 90 children

Outdoor Activity Space Measurements:
Preschool Playground: 113 x 71 = 8,023 sqft.
Total= 8,023 divided by 75= 106 children

Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment. An adequate amount of cushioning material is in place under the equipment. Shade is provided by pop-up umbrellas. Drinking water is available by children bringing their water bottles from home and a water jug is available for refills.

Fire clearance approval letter on file and dated 10/19/2021, adding classroom #14.

Facility provides Incidental Medical services.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director 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.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021

LIC809 (FAS) - (06/04)

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