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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613978
Report Date: 02/12/2020
Date Signed: 02/12/2020 03:12:46 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:MARGUERITE CHRISTIAN SCHOOLFACILITY NUMBER:
300613978
ADMINISTRATOR:JOHNSTON, SUZEEFACILITY TYPE:
850
ADDRESS:26558 MARGUERITE PARKWAYTELEPHONE:
(949) 582-5856
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:116CENSUS: DATE:
02/12/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Suzee Johnston Site DirectorTIME COMPLETED:
03:35 PM
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On the above date Licensing Program Analyst (LPA) Jordann Nelson met with Suzee Johnston in regards to Case Management Incident report. The incident was self reported and followed reporting requirement guidelines. During the visit LPA Nelson conducted a safety inspection of the facility, No physical plant concerns were observed during the inspection. LPA Nelson reviewed the personnel roster to ensure all staff were cleared and associated correctly to the facility.

An Unusual Incident Report was submitted whereby a child put hands on another child on the school play ground.Interviews were conducted with the site director who stated that the location where the incident took place has been moved off the school yard. The site director stated that supervision was in place at the time of the alleged incident and that staff are positioned at various locations on the play yard. A meeting was held with the teachers to ensure moving forward that all areas must be visible for staff to see and monitor the interactions of the children. LPA Nelson conducted a review of the file an no history of past incidents were indicated or any history of such events in the past. The advisory note is a reminder to have staff positioned on the yard an do constant visual sweeps and to constantly monitor children and to respect one another's personal boundaries. .

The Notice of Site Visit was provided and posted.Facility representative 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.
Appeal Rights explained. All appeals must be in writing and received by the licensing office within 10 days.
The facility representative was informed that she can refer to the Department's website for obtaining updates. This report is to be on file and accessible for public review at the facility for at least 3 years.
Exit interview was conducted.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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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