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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270517
Report Date: 05/24/2019
Date Signed: 05/28/2019 08:37:09 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:SAINT FRANCIS OF ASSISIFACILITY NUMBER:
304270517
ADMINISTRATOR:MARTINSON, CHERIFACILITY TYPE:
850
ADDRESS:5300 EASTSIDE CIRCLETELEPHONE:
(714) 695-3700
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY:66CENSUS: 55DATE:
05/24/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Cheri MartinsonTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Han conducted a Case Management inspection. LPA Han met with director, Cheri Martinson at the time of the visit. LPA toured the facility inside and outside. The census observed was 7 preschool staff 55 preschool children. Children were playing at the playground at the time of visit. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions

During the inspection on 5/9/5019, the facility was issued an A violation for being out of ratio compliance. It was observed during a physical plant and record review. On 5/9/2019, LPA verified that staff#3 and staff#5 in Room#B did not have qualified teachers. Room#B had 2:19 teacher and child ratio at 10:30AM on 5/9/2019. LPA also verified that staff#4 and staff#6's transcripts in Room#C. Room#C had only one fully qualified teacher. Room#C had 2:20 teacher and child ratio at 10:30AM on 5/9/2019. This was an immediate threat to the children's health and safety and were issued as A violation during the inspection on 5/9/2019. On 5/9/2019, Cheri Martinson, director, was not available at the facility. Administrator, Fran Montelli, assisted LPA Han to verify staff transcripts and other licensing required staff forms from staff file cabinet.



On 5/17/2019, director sent staff#5's transcripts to LPA by email. LPA verified that staff#5 is a fully qualified teacher. During today's case management inspection, director provided staff#3 and staff#4's transcripts to review by LPA. LPA verified staff#1, staff#2, staff#3, staff#4, staff#5, and staff#6 are fully qualified teachers. Each staff is qualified to have 1:12, teacher and children ratio. Director is informed to keep all transcriptions and licensing office required forms in file to review by LPA during the inspection. During the inspection on 5/24/2019, LPA verified all other missing required forms for staff. LPA also observed LIC 9224 form that issued on 5/9/2019 with parent's signature for 10 out of 55 children files.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
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: SAINT FRANCIS OF ASSISI
FACILITY NUMBER: 304270517
VISIT DATE: 05/24/2019
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It was observed that all classrooms are operating within compliance of teacher and child ratio regulation. No other violation of regulations were observed during the inspection. Exit interview was conducted. The report was reviewed and discussed. Notice of Site Visit was posted during the visit. The 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. The facility was provided a copy of their appeal rights (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. The facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov This report is to be on file and accessible for public review at the facility for at least 3 years.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
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