304270640-9-16-2019-06-CC-MMAK-BG3NSV-20190916104345

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270640
Report Date: 09/16/2019
Date Signed: 09/16/2019 10:43:49 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:	PILLARS ACADEMY		FACILITY NUMBER:	304270640
ADMINISTRATOR:	KAZI, ZUBEDA		FACILITY TYPE:	850
ADDRESS:	23581 MADERO DRIVE # 104		TELEPHONE:	(949) 951-0442
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	48	CENSUS: 16	DATE:	09/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	Director		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	An unannounced annual random inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek who met with the director, Zubeda Kazi. Census was taken and there were a total of 16 preschool children in two different classrooms and on the playground with a total of 4 staff observed. (Rooms 105A, 105B, and 103A).There were ten children with two staff in room 105A, five preschool children with one staff in room 105B, and there was no children in toddler option room 103 A. One toddler from toddler option program with one staff was on the playground. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture was inspected to ensure it's in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. The food preparation area was inspected for cleanliness, free of rodents/vermin, appropriate storage of food, and verification of posted menus. There are no weapons, firearms or bodies of water in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (MMR, Pertussis, and Flu vaccines. A sample of children's files were reviewed for completeness of admission agreement, verification of sign in/out including time the child was signed in/out by authorized representative as well as verification of representatives full legal signature. (The facility is equipped with electronic sign in/out procedure). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Continued on page 2

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

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: PILLARS ACADEMY	FACILITY NUMBER: 304270640
	VISIT DATE: 09/16/2019

NARRATIVE

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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. LPA discussed with applicant that a plan must be submitted to the licensing office within 30 days indicating that IMS services are being provided. The plan should describe the facility’s policies and procedures that ensure the proper safeguards are in place. Topics to be covered include but not limited to:-Types of IMS to be provided (Blood Glucose Testing; Inhaled Medication; EPI-PEN; Glucagon; G-Tubes); -Records and Authorizations; ·Storage; ·Staff training; ·Safety precautions; ·When to call 911 ·Reporting Requirements need to be in the plan. Refer to Title 22 Sections 102417 and Health and Safety Code Section 1596.750 and 1507. Technical assistance can be found at http://ccld.ca.gov/PG546.htm and http://ccld.ca.gov/PG2105.htm .

The 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 will result in civil penalties of $100. The licensee was provided a copy of their appeal right (LIC 9058 1/16) 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. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates.
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

A copy of child care provider's guide to safe sleep pamphlet and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative on the last inspection.
An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the licensee today.

In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12.
This report ends here.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019

LIC809 (FAS) - (06/04)

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