304270251-7-14-2022-06-CC-KDEI-CGBR23-20220714123739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270251
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:37:51 PM

Document Has Been Signed on 07/14/2022 12:37 PM - It Cannot Be Edited

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) 285-1652
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	70	CENSUS: 13	DATE:	07/14/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Ms.Bullock, Laura		TIME COMPLETED:	12:45 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	Licensing Program Analyst (LPA) Desai, Ketki conducted an announced Case Management Licensee initiated inspection at the above facility for the purpose of increasing the Preschool age capacity by adding one new room # 603 and removing room # 201 in Building "D". There is a Private Elementary school on premises. LPA observed 13 preschool age children with two staff members, providing care and supervision to the children in Room # 607 while there were no children in other classrooms due to summer break. Currently facility is licensed for 70 Pre-school age children, 2 years to 6 years old in four assigned rooms # 602/ 607/ Kinder readiness and Room # 201 in Building D. Now facility is removing Room # 201 in Building D and adding Room # 603, increasing their total preschool capacity to 84 children. Preschool age program has their own yard. Facility shall now use Room # 602/ 603/607 and Kinder readiness class rooms for Preschool program. Facility Director Ms. Bullock, Laura gave a tour of the four classrooms. The following was observed in the following in the preschool room · Age appropriate furniture and equipment’s · Educational items /Arts and Crafts activities. · Room is well lighted with ventilation. · Drinking water is available through filtered water dispensers placed in each classrooms and personal water bottles (1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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: 07/14/2022

NARRATIVE

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· Facility offers AM/ PM snacks to the preschool age children. Lunch is brought from home and stored in the individual cubbies.
Children nap on cots, linens and blankets are brought from home and washed weekly at home.
· Electronic sign in and out
· CDC Guidelines are being followed.
· Classrooms has specific age appropriate bathrooms.
New Classroom # 603: Children in this classroom, shall use the bathroom and sink in the Elementary school area. The classroom has a portable sink but no bathroom. Facility shall request a Waiver to use the designated bathroom in the Elementary school area.

On today’s inspection four preschool rooms were measured.

Indoor activity space: 3329'97 divided by 35= 95'14 (Facility has sufficient space to accommodate 84 preschool age children in the four assigned rooms)

Total sinks: 7 X 15 = 105 children / Total toilets: 6 X 15= 90(children)
Facility has sufficient sinks and toilets to support the requested capacity of 84 preschool age children.

Outdoor space: Facility has a designated Preschool age yard, which is at the end of the building in front of Room # 607 and Kinder readiness classroom, there is toilet and sink in the yard area, which shall be used by Preschool children during outdoor activities.
Preschool age yard has a surrounding fence with soft cushion flooring, placed on the age appropriate toy structures with shade to absorb any falls and shade is provided by a building structure and a shaded canopy. Age appropriate toys and play structures were observed in the yards

Outside measurements: 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 shall be submitted as a new classroom is being added. (2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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: 07/14/2022

NARRATIVE

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After a tour of the center, no deficiency was observed.

Facility Administrator is current on the required Pediatric CPR/First Training: Valid up to October 1st 2023.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian Facility has access to the Guardian system.

Fire clearance has been granted by Orange County Fire Authority for the requested capacity of 84 children.

New License shall be issued, for 84 Preschool age age children (2-6 years old) in Room # 602/ 603/607 and Kinder Readiness room. Operating hours: Monday to Friday 7:00 am to 5:30 PM.
Facility shall request a waiver for Outdoor yard and shared bathrooms.
Criminal Record Statement : Facility Representative (Ms. Bullock, Laura ) was was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Safe Sleep : LPA discussed the safe sleep regulations with Facility Representative (Ms. Bullock, Laura ) discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. (3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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: 07/14/2022

NARRATIVE

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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Exit Interview :Exit interview conducted and report was reviewed with the Facility Representative.

Ms. Bullock, Laura)

Review of records to be maintained : LPA reviewed with Facility Representative (Ms. Bullock, Laura ), the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Notice of Site Visit : A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC809 (FAS) - (06/04)

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