300613936-7-26-2021-06-CC-MMAK-C5ASLY-20210726135907

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300613936
Report Date: 07/26/2021
Date Signed: 07/26/2021 01:59:16 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:	MISSION VIEJO CHRISTIAN KIDS CLUB		FACILITY NUMBER:	300613936
ADMINISTRATOR:	SWEETSER, JOHN		FACILITY TYPE:	840
ADDRESS:	27192 JERONIMO ROAD		TELEPHONE:	(949) 465-1954
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92692
CAPACITY:	175	CENSUS: 99	DATE:	07/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Director		TIME COMPLETED:	02:15 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	Page 1 of 3 Licensing Program Analyst (LPA),Mahnaz (Nancy) Malek conducted an on site inspection for the purpose of an Annual Required- 1 year. The Covid-19 Emergency Response questionnaire was reviewed and answered by the director, John Sweetser before entering the facility. LPA toured the facility inside and outside. The floor and yard plan (LIC 999) were verified. This facility runs a before and after school, and summer program. There were 99 school age children present with 8 staff in the outdoor space in different groups. Due to COVID 19 guidelines, LPA observed staff and children were following CDC and Dept of Public Health Guidelines. 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. LPA provided Guardian Information and website info:https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. During the inspection of the indoor activity space, items which could pose a danger to children (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. AM and PM snacks are provided by the facility. Menu was posted. Lunches are provided by parents. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors and outdoors. The children's bathrooms are clean and sanitary. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility Staff files were reviewed for staff present during the facility inspection on this date. Nine staff files were reviewed. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, 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. Proof of immunization Continued on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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 4

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: MISSION VIEJO CHRISTIAN KIDS CLUB	FACILITY NUMBER: 300613936
	VISIT DATE: 07/26/2021

NARRATIVE

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against pertussis, measles for staff were reviewed and within compliance. 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. Among 9 reviewed staffs' files, 6 staff did not meet this requirement. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications. Four staff had current certificates.
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. She was also informed that the LIC 508 must be submitted with all Criminal Background Clearance. LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian.
Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of (5) of 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). In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.
The medication stored were reviewed. 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 facility has a waiver in place for this requirements) The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material produced for the purpose around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. 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.
The director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov The facility has been added to email list to receive Quarterly Update from the Department.
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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MISSION VIEJO CHRISTIAN KIDS CLUB	FACILITY NUMBER: 300613936
	VISIT DATE: 07/26/2021

NARRATIVE

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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 which 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. In the areas that were evaluated, The following deficiency was observed of the California Code of Regulations, Title 22, Division 12 at this inspection date. Please see LIC 809 D for the deficiency cited.

An exit interview was completed with director. 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. The director 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)
- Emergency Disaster Plan (LIC 610)
- Fire Drill Log

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: MISSION VIEJO CHRISTIAN KIDS CLUB	FACILITY NUMBER: 300613936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/26/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/16/2021 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who , on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reported training provided pursuant to paragraphs(2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every 2 years
	8 9 10 11 12 13 14	following the date on which he or she competed the initial mandated reporter training. This requirement was not met as evidenced by reviewing 9 staffs' files today resulting missing certificates for 6 staff. The licensee failed to meet this section of the regulations. This is a potential hazard to the health and safety of children in care.	8 9 10 11 12 13 14	The missing certificate for Mandated Reporter Training are for staff # 1, 2, 3, 4, 5, and 9
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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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

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