304270938-7-12-2023-06-CC-ABOI-CTNPC8-20230712111127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270938
Report Date: 07/11/2023
Date Signed: 07/12/2023 11:13:15 AM

Document Has Been Signed on 07/12/2023 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SAN CLEMENTE PRESCHOOL, THE		FACILITY NUMBER:	304270938
ADMINISTRATOR:	PITKIN, HEIDI		FACILITY TYPE:	850
ADDRESS:	163 AVENIDA VICTORIA		TELEPHONE:	(949) 498-1025
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92672
CAPACITY:	75	CENSUS: 38	DATE:	07/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Corinnne Budrovic / Heidi Nau		TIME COMPLETED:	04:30 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	On 07/11/2023 Licensing Program Analyst (LPA), A. Bootorabi conducted an onsite visit for the purpose of a 1 year required inspection. LPA and Assistant Director (AD) Corinne B. toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Upon arrival, an Entrance Checklist (LIC 125) was provided to Assistant Director Corinne B. Census was taken upon entry of each classroom: Room #1 - 11 Children 2 Teachers Room #2 - 9 Children - 2 Teachers Room #3 7 Children - 1 Teacher Room #4 - 7 Children - 1 Teacher Room #5 - 5 Children - 1 Teacher *Documents reviewed and to be posted in a prominent, publicly accessible area at the facility:* Facility License, Waivers (if applicable), Menus, LIC 613A Personal Rights, PUB 269, PUB 393 Notification of Parent Rights, and LIC 610 Emergency Disaster Plan. 5 of 5 documents were posted by the front door and visible to the public. The facility was missing LIC 610 Emergency Disaster Plan. LIC 610 was posted in the staff room and not publicly accessible. LIC 610 was moved to the front and place by license board. *Documents to be reviewed during inspection:* Verification of Disaster and Fire Drill, Daily Activity Schedule, Sign In/Out Sheets, and LIC 9148 Earthquake Preparedness. The facility had 3 of 4 documents available for review. LIC 9148 Earthquake Preparedness was not available for review and a consultation was provided. The LIC 9148 was posted and available for review during inspection after consultation. The last Fire Drill was conducted on 6/9/2023. The facility is using an electronic system to sign in and out. The facility provides a pin number to the child's parent(s)/guardian. A consultation was provided to director Heidi N. and AD Corinnne about the importance of making sure the right person is using the pin for pick up and drop off. The facility uses their cell phones or paper sign in/out if internet goes down. The facility’s sign-in and out procedure does not include: The person who signs the child in/out to use his/her/they full legal signature.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
	VISIT DATE: 07/11/2023

NARRATIVE

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Classrooms 1 - 5 were toured with the director and AD. Classrooms 5 of 5 were inspected and the activity space, and items that could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. A consultation was provided for a room that had cleaning compounds that were not stored in a locked area.
The tables and chairs were observed to be scaled to the size of the children in the classrooms. All play equipment and materials used by children were observed to be age appropriate. The facility provided a variety of age-appropriate equipment, toys, and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities. Furniture and equipment were observed to be maintained in good condition, free of sharp edges, loose, or pointed parts.
NAPPING EQUIPMENT Cots used for napping were observed to be maintained in a safe condition. Napping equipment was observed to be arranged so that each child has access to a walkway without having to walk on or over the cots or mats of other children. The bedding was observed to be stored so that each child’s bedding is identifiable and no child’s used bedding comes into contact with other bedding.
DRINKING WATER Drinking water was observed and readily available to children in indoors in water bottles brought from home. The director stated that water is accessible to children outside. Refills are made by water that is delivered to the facility.
LPA observed water fountains in classrooms but water was closed to avoid children from using it.
FOOD SERVICES The facility does not provide meals to children. Children bring their meals from home. The facility provides a AM and PM snack to children in care.

IDENTIFICATION AND LOCATION OF MEDICATION STORED IN THE FACILITY
The LPA observed medication being stored in the classroom not in a locked box and consultation was provided. The LPA reviewed the record of current medications, including the name of the prescribing physician, and instructions. LIC9221 was missing in child's file and facilities form does not match LIC 9221. A consultation was provided.
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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to the publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
	VISIT DATE: 07/11/2023

NARRATIVE

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A functioning carbon monoxide detector and smoke alarm were tested by the A. director during today’s visit and were observed to be functioning. A fire extinguisher was observed in classroom 2.

Outdoor Space: The surface of the outdoor activity space was observed to not be maintained in a safe condition for activities. The surface of the outdoor activity space was observed to have a hazard including a large whole on the ground by the gate closest to the public street. The whole was covered by sand during the inspection to prevent children from tripping over it. The director stated it would be covered by cement.

The cushioning material used underneath the climbing structure in the outdoor space for the gated toddler play area and non-gated area for older children with the climbing structures consists of artificial grass and foam like cushion material is placed underneath the climbing structure but more softer in fall zones stated by licensee/owner.
The outdoor equipment and toys were not in good repair and were not free of sharp edges. The LPA consulted the director regarding the toys that are sun damaged and causing sharp edges to occur as they break. The toys were observed to be removed from the play areas during inspection.

There are no bodies of water present at the facility. The facility’s outdoor grounds are safe, sanitary, and in good repair and a consultation was provided.

PERSONNEL RECORDS : The LPA requested to review staff records of adults working directly with children. The following documents were requested for review exemptions or exemptions, Staff Qualifications, Immunization Records, LIC 9052 Employee Rights, LIC 9108 Statement Acknowledging Requirement to report Child Abuse, 1 CPR First Aid Certification of staff present at the facility at all times, TB clearance, and a Mandated Reporter Training Certificate.
The facility had one separate file for each staff member. The files reviewed during today’s visit were observed to not be completed. Mandated Reporter Training was expired for some staff. LIC 9108 was not identified in the files reviewed.
A consultation was provided to facility director and assistant director.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
	VISIT DATE: 07/11/2023

NARRATIVE

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A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Licensee and facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Children’s Records Reviewed:The LPA requested a complete children’s records of children enrolled in the program. Children's records were reviewed, and there was a separate, complete, and current record for each child. The LPA reviewed files to verify the following documents Immunization Records, LIC 700 Identification, Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. The children’s records were not complete currently. A consultation was provided for LIC995A (provide top portion to parents) and LIC 700 not available for review. Facility uses their own Emergency Information sheet that does not cover all information on LIC 700.

Child Care Licensing Program Webinars: The Child Care Licensing Program is pleased to continue offering
webinars to share important information with the childcare licensing community in 2023.
2023 Webinar Schedule
• Tuesday, September 26, 2023, 6:00 p.m.
• Tuesday, December 12, 2023, 6:00 p.m.
To register for webinars, see Provider Information Notice (PIN), PIN 22-30-CCP.

Licensee and facility representative was informed of the www.MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
	VISIT DATE: 07/11/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA verified that the lead testing was not completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE

LPA referred the licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

The facility did not meet the California Code of Regulations, Title 22 Division 12, and regulations not met were observed, discussed, and cited at the time of the visit.

The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today:1597.16(a)(1) - 596.8662(b)(1) - 101221(b)(5), 101223(b)(1)
Due to the Type A violations cited today, 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 them to the parents/guardians of children newly enrolled at the facility during the next 12 months. 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 of the Proof of Correction for 30 consecutive days.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited aboveby means of not having a lead test completed which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2023
	Plan of Correction
1 2 3 4	The director stated she will be scheduling someone to come out. The director had already emailed two potential lead testing facilities during inspection. Licensee will provide proof of test once completed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by means of having staff not retake mandated reporter training every 2 years which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/25/2023
	Plan of Correction
1 2 3 4	The licensee will send copies of the mandatated reporter training for staff via email by 7/25/2023.

Type B

Section Cited

CCR

101221(b)(5)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (5) Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by means of not having an LIC 700 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/01/2023
	Plan of Correction
1 2 3 4	The licensee will be emailing proof of correction via email to LPA by 8/1/2023

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 Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101223(b)(1)

Personal Rights

(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by means of having the top portion in files and not provided to parents which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/01/2023
	Plan of Correction
1 2 3 4	The licensee will provide proof of correction via email to LPA. And moving forward a copy of this document will be provided to parents.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAN CLEMENTE PRESCHOOL, THE	FACILITY NUMBER: 304270938
	VISIT DATE: 07/11/2023

NARRATIVE

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Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name).

Appeal Rights were explained. The Licensee was provided a copy of 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 Regional Office within 15 business days. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

End of Report

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli Bootorabi	TELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023

LIC809 (FAS) - (06/04)

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