304270251-2-18-2021-06-CC-KDEI-BYCQ3X-20210218104928

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270251
Report Date: 02/18/2021
Date Signed: 02/18/2021 10:49:34 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:	MISSION BASILICA SCHOOL		FACILITY NUMBER:	304270251
ADMINISTRATOR:	BULLOCK, LAURA		FACILITY TYPE:	850
ADDRESS:	31641 EL CAMINO REAL		TELEPHONE:	(949) 234-1385
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	59	CENSUS: 38	DATE:	02/18/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Ms.Bullock Laura		TIME COMPLETED:	11:00 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	A case management Licensee initiated unannounced inspection was conducted on this date by LPA Ketki Desai. The purpose for today’s inspection was to evaluate the facility for a capacity increase as requested by the Licensee. LPA met with Director Ms. Bullock Laura, who gave the tour of the one new classroom # 201 in Building D on the school premises Facility is currently licensed for 59 Preschool age children and is seeking to increase capacity to 71 children ages from 2 to 6 years of age, Monday through Friday, 7.00 AM to 5.30 PM.The program will continue to use the previously assigned rooms (Room # 602, 607 and Kinder Readiness room) located on the school premises. All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, and mat/cot were inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure. An adequate amount of cushioning material is in place under the equipment. Shade is provided by wooden patio covering and a Water pitcher and personnel water bottles are used for drinking water. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, and criminal records clearances/exemption transfer requests. New Classroom # 201 in Building “D” was measured today. This room has one small art section and big area with two toilets inside the room with two sinks for easy accessibility.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021

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: MISSION BASILICA SCHOOL	FACILITY NUMBER: 304270251
	VISIT DATE: 02/18/2021

NARRATIVE

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Room # 201 (Big room) 19 x 17. 42= 330’98
Room # 201 (Art area): 7’5 x 6 =45

Total indoor capacity: 375’98 divided by 35= 10.74 (11 children)

Total sinks= 2 x 15= 30 / Total toilets = 2 x15=30

Outdoor: Facility has enough outdoor space for the requested capacity of 70 children.

Total yard is 3338 square feet divided by 75 = 45 children

Facility has an approved Waiver on file for a Staggered schedule in-between the three Preschool classrooms, but an updated Waiver request has been requested as a new classroom is being added.

Fire clearance from the Orange County Fire Authority has been received on 1/19/21 and approved for 95 children, as initially Licensee had requested to add two classrooms but an updated LIC 200 A was received on 2/16/2021 at the RO, adding only one classroom and changing the capacity to 71.

Based on today’s indoor measurements of the new classroom, capacity can be approved only for 11 children instead of 12 children.

Licensing report was reviewed with the director. The director was informed that capacity is limited to 70 children due to indoor activity space. The new room by measurement can only accommodate 11 children bringing total capacity to 70.

After a tour of the center, no deficiency was observed. File will be submitted for approval as of today.

Exit interview conducted. Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021

LIC809 (FAS) - (06/04)

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