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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270517
Report Date: 05/09/2019
Date Signed: 05/10/2019 08:52:04 AM

COMPREHENSIVE INSPECTION
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: 37DATE:
05/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:55 AM
MET WITH:Frances Montelli - Assistant PrincipalTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Han conducted an unannounced annual/random inspection of the facility on today's date. LPA Han arrived school site at 7:55AM. LPA had to wait for 20 minutes to meet assistance Principal, Frances Montelli. Preschool director, Cheri Martinson, was off due to personal matter. LPA Han toured the facility with the assistant principal, Frances Montelli, inside and outside. Census was taken in individual classrooms. The overall census observed was 6 preschool staff and 37 preschool children at 8:20AM. 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. Operating hours are 7:00 am- 6:00 pm, Mon-Fri.

The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Food is not prepared on site. Children bring their own lunch and snacks. Facility offers daily hot lunch for children who want to purchase by 3rd party vendor. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary. Children nap on cots/mats, and bedding is taken home weekly to be washed by parents. The facility has conducted an emergency drill within the past six months. The facility has a working smoke detector and fire extinguisher. Carbon monoxide detector was not available to test up on request.

The playground was completely fenced. The playground equipment appeared in safe condition. There is sufficient cushioning underneath climbing structures and/or play equipment to absorb falls. Sign in/out procedure was reviewed for compliance.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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
VISIT DATE: 05/09/2019
NARRATIVE
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During today’s visit, staff#1 stated room#A has up to 21 children with a fully qualified teacher and a teacher aide, Staff#3 stated room#B has up to 22 children with a fully qualified teacher and a teacher aide. Staff#4 stated room#C has up to 20 children with a fully qualified teacher and a teacher aide all day. LPA Han checked teacher and children ratio at 8:30AM and 10:30AM twice. At 8:30 AM, each room had 17:2, 18:2, 12:2 in order by room #a, b, c. At 10:30AM, each room had 17:2, 19:2, 20:2 in order by room #a, b, c. During the inspection it was determined the facility is not operating within compliance of staffing ratios.

At least one staff member present possesses current CPR/First Aid certifications, which expires 8/2019. Children's and staff files were reviewed for compliance. Children's and staff files were not in compliance.

The facility does provide Incident Medical Services.

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 Family Child Care Homes Section 102417. 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
In the areas that were evaluated, the facility was not in compliance and violation(s), in accordance with California Code of Regulations, Health & Safety 1596.7995(a)(1), is being cited on the attached LIC 809D.

Proof of immunization against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792.
Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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: 05/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2019
Section Cited

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1596.954 Carbon monoxide detectors required; inspection Every licensed child day care center shall have one or more carbon monoxide detectors in the facility...account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
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Based on observation and interview, school principal stated the school doesn't have carbon monoxide. The licensee failed to ensure to install carbon monoxide detector. 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2019
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
VISIT DATE: 05/09/2019
NARRATIVE
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NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
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

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The facility representative 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 facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
- Admissions Policies and Procedures/ Fee schedule
- Daily Activity Schedule

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal Rights and deficiencies were discussed. The director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2019
Section Cited

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101218.1 (d) Admission Procedures and Parental and Authorized Representative's Rights (d) The licensee shall provide to the parent or authorized representative the LIC 995E (8/02), Caregiver Background Check Process form. This requirement is not met as evidenced by:
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Based on record review of Chilldren file, 4 out of 10 children doesn't have Parent's right in the 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2019
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: 05/09/2019
NARRATIVE
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The director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00
If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/15/2019
Section Cited

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101216.3 Teacher-Child Ratio(b) (1) A ratio of one fully qualified teacher...and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d). This requirement is not met as evidenced by:
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Based on LPAs observation at the each classroom at 10:30AM, room#B and C were out of ratio as 19:2 and 20:2. There were a teacher and a teacher aide in each classroom. This poses an immediate 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7