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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270517
Report Date: 02/20/2020
Date Signed: 02/20/2020 02:11:43 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:SAINT FRANCIS OF ASSISIFACILITY NUMBER:
304270517
ADMINISTRATOR:FRY, DEBBIEFACILITY TYPE:
850
ADDRESS:5300 EASTSIDE CIRCLETELEPHONE:
(714) 695-3700
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY:66CENSUS: 47DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jeannette Lambert - School principal TIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Jungmi Han conducted an onsite inspection for the purpose of an Annual Required. LPA and Jeannette Lambert, school principal toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. The facility has a private kindergarten component. School principal stated the director is off on Thursday. Census was taken in individual classrooms. LPA observed 2 staff with 18 preschool children in Room A, 2 staff with 12 preschool children in Room B, and 3 staff with 17 preschool children in Room C. The overall census observed was 7 preschool staff and 47 preschool children. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. LPA met staff, Brooke Freeman in Room C. Brooke Freeman stated she started work at this facility since 8/2019 as part time. Brooke Freeman was not on the facility personnel report summary on this date. LPA verified Brooke Freeman has active status on current caregiver background checks, but not associated to this facility.

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. Food is not prepared on site; Children brings their own lunch and snacks. Hot lunch is provided by school district. The facility keeps extra food for children in teacher supply room. Food prep areas were clean and sanitary. Food is properly stored. Hot lunch menus were posted where they could be reviewed 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 by cups and tap water and sprits bottles with the child’s name on it. The children's bathrooms are clean and sanitary. Children nap on personal floor mats and bedding is stored individually and is taken home weekly to be washed by parents. LPA observed floor mat for napping is less than 0.5 cm thick. LPA took a picture of children's floor mats for record. The facility has conducted an emergency drill within the past six months. The facility has a working carbon monoxide detector and fire extinguisher.
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2020
Section Cited

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101170 (e)(2) Criminal Record Clearance (e) All individuals subject to a criminal record review ... prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement is not met as evidenced by:
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Based on record review and interview, Brooke Freeman worked at the facility without clearance transfer since 8/2019. The director failed to submit transfer request form to licensing. This poses a potential Health and Safety risk to the children in care.
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Type B
03/20/2020
Section Cited

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101239.1 (b)(1) Napping Equipment (b) Floor mats used for napping shall be:
(1) Constructed of foam at least 3/4 inch thick. This requirement is not met as evidenced by:
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Based on observation, the director failed to ensure to have a napping floor mat with at least 3/4 inch thick. This poses a potential Health and Safety risk to the children in care.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 2 of 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2020
Section Cited

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1596.8662.(b)(1)… mandated reporter…proof of completion ...January 1, 2018, is a licensed child care provider..shall complete the mandated reporter training provided...renewal mandated reporter training every two years...This requirement is not met as evidenced by:
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Based on record review, the director failed to renew staff#2 and staff#3's mandated reporter training certificate. Both expired on each 2/19/20 and 2/17/20. Director also failed to ensure to obtain certificates from staff#4 and #7. This poses a potential Safety risk to the children in care.
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Type B
03/20/2020
Section Cited

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1596.7995 (c )Employees or volunteers at day care center; immunization requirements; records; exemptions (c) The day care center shall maintain documentation of the required immunizations...the day care center. This requirement is not met as evidenced by:
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Based on record review of staff#7, director failed to ensure to maintain staff#7's immunization records (Pertussis, Measles, and influenza vaccine) in staff file.
This poses a potential Health and Safety risk to the children in care.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 3 of 7
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2020
Section Cited

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101217 (a) Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
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Based on record review and interview, Staff#7 worked at the facility since 8/2019. The director failed to ensure to maintain staff#7's personnel records including LIC 503, LIC 508, LIC 9052, etc. in staff file. This poses a potential Health and Safety risk to the children in care.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: 02/20/2020
NARRATIVE
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Facility met all posting requirement. The California Child Passenger Safety Law (PUB 269) was posted by the entrance of the facility

Staff files were reviewed for staff present during the facility inspection this date. 7 out of 7 staff files were reviewed. Health screening and immunizations as required were reviewed. Staff#7 did not have Health Screening (LIC 503), Criminal Record Statement (LIC 508), Employee Rights (LIC 9052), immunization record, mandated reporter training certificate, and transcripts in staff file.

Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a child care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization 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. LPA observed staff#2 and staff#3's certificate has been expired as of 2/19/2020 and 2/17/2020. Staff#4 and staff#7 did not complete mandated child abuse reporter training. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 8/2021.

The school principal 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. The school principal was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182).

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 10 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) and a medical assessment. 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.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 02/20/2020
NARRATIVE
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This facility provides Incidental Medical Services - (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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 surface of the outdoor activity space was well maintained and free of hazards. The cushioning material woodchips around the climbing equipment, swings, slides and other similar equipment appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by drinking fountain or sprits bottles with the child’s name on it. 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 school principal was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov. The school principal may request to be added at www.ccld.ca.gov to receive a Quarterly Update.

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 school principal was informed, and website given, about the California Child Care Disaster Plan 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.
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the school principal.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: 02/20/2020
NARRATIVE
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Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Based on LPAs observations, record reviews, and interviews, the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101170 (e)(2) Criminal Record Clearance, 101239.1 (b)(1) Napping Equipment, 101217 (a) Personnel Records and Health and Safety 1596.8662.(b)(1), 1596.7995 (c) are being cited on the attached LIC 809D.

An exit interview was completed with school principal. he 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 facility representative 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.

End of report

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 7 of 7