304270965-12-5-2022-06-CC-DTHN-CLTQZ6-20221205113614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270965
Report Date: 12/05/2022
Date Signed: 12/05/2022 11:36:28 AM

Document Has Been Signed on 12/05/2022 11:36 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:	CONCORDIA ELEMENTARY		FACILITY NUMBER:	304270965
ADMINISTRATOR:	COPELAND, MELONIE		FACILITY TYPE:	850
ADDRESS:	3120 AVENIDA DEL PRESIDENTE		TELEPHONE:	(949) 492-3060
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92672
CAPACITY:	24	CENSUS: 12	DATE:	12/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Gretchen Fleming		TIME COMPLETED:	11:55 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	Licensing Program Analyst (LPA), Thompson conducted an onsite inspection for the purpose of an Annual Random. LPA toured the facility inside and outside. The floor and yard plan (LIC 999) were verified. LPA observed a total of 12 preschool age children with 2 staff. Facility hours are Monday through Friday, 8 AM to 3 PM. \ LPA arrived at 8:45 AM and notified Instructional Aide (S1) Children's records will need to be reviewed as well ad staff files. At 10:00 AM LPA did not have access to children files. S1 stated the files are not on campus and are online. S1 stated children files were being emailed over. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. 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. During the inspection of the indoor activity space, LPA did not observe any items which could pose a danger to children (poisons, detergents, cleaning compounds, medications or hazardous items). There is filtered drinking water available indoors for children in care. The children's bathrooms are clean and sanitary. Menus were posted where they could be reviewed by parents. Children have the option to purchase or bring lunch from home. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. Continue to page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

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

FACILITY NAME: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
	VISIT DATE: 12/05/2022

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The facility has not conducted an emergency drill within the past six months, last scheduled drill provided by S2 was on 6/1/22. The facility has a working carbon monoxide detector and fire alarm. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility.

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. . Drinking water is available near the activity space. 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.

Out of the two staff present, one staff file was available for review during the facility inspection this date. Health screening and immunizations as required were reviewed for S1. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a childcare center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for S1 were reviewed and within compliance. LPA observed S1 and S2 did not have a current CPR certification. S1 mandated reporter certification expired 9/9/21 and S2 file was unable to be reviewed at the time of visit. 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.

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/process.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

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: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
	VISIT DATE: 12/05/2022

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

Staff was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

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 director was informed, and website given, about the California Child Care Disaster Planhas 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

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

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

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: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
	VISIT DATE: 12/05/2022

NARRATIVE

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Important COVID-19 resources and links were provided:
· COVID-19 Update Guidance Childcare Programs/Providers link:
https://files.covid19.ca.gov/pdf/guidance-childcare.pdf
· CCLD COVID-19 Licensed childcare and facilities and provider FAQs link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources/faqs-for-licensed-child-care-facilities-and-providers
Safe, free, and effective COVID-19 vaccines are now available to everyone age 16 and up. Every Californian can sign up at myturn.ca.gov or call (833) 422-4255 to get their COVID-19 vaccine appointment.

Staff was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

In the areas that were evaluated, Seven (7) deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Physical Plant - Type B: 101174(d), Staff Records - Type B: 1596.8662(b)(1), Staff Records - Type B: 101216(f), Staff Records - Type B: 101217(a)(12), Staff Records - Type B: 101217(d), Children Records - Type B: 101221(a), and Reporting Requirements - Type B: 101212(b).

Exit interview conducted and report was reviewed with Principal Gretchen Fleming . A notice of site visit was given and must remain posted for 30 days.

Appeal Rights and deficiencies were discussed. Principal 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.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2022 11:36 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: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. S2 provided the fire/disaster drill schedule which shows last drill was condcuted on 6/1/22 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit fire/disaster drill log to LPA by POC due date.

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. During staff file review, LPA observed S1 Mandated Reporter Certification expired on 9/9/2021 and S2 was unable to provide a copy of their mandated reporter certification which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit proof of current mandated reporter certification to LPA by POC due date.

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 Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2022 11:36 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: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. 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. Two staff present during todays visit did not have a current first aide/ CPR certification which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit proof to LPA of first aide/ CPR certifications by POC due date.

Type B

Section Cited

CCR

101217(a)(12)

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: (12) Tuberculosis test documents as specified in Section 101216(g). 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. S2 did not have a file available for LPA to review Tuberculosis test documents which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit proof to LPA by POC due date.

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 Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/05/2022 11:36 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: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. 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. Sub Teacher S2 personnel records were unavailable for LPA to review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit Sub Teacher (S2) staff qualifications, proof of immunization records, LIC 503 Health Screening Report, LIC 9052 Employee Rights, and LIC 9108 Statement Acknowledging Requirement to Report Child Abuse to LPA by POC due date.

Type B

Section Cited

CCR

101221(a)

Child's Records

(a) The licensee shall ensure that a separate, complete and current record for each child is maintained in the child care center. 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. Children files for Twelve children present were not available for review which poses/posed a potential health, safety or personal rights risk to persons in care. LPA informed instructional aide children files will need to be reviewed. Instructional aide informed LPA at 10:00 AM children files were not onsite and will need to be emailed over.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit the following forms to LPA by POC due date for the Twelve children present. LIC 613A Personal Rights, Admission Agreement, Immunization records, LIC 700 Identification and Emergency Information, LIC 701 Physician Report, LIC 995 Notification of Parent Rights, and LIC 627 Consent for Emergency Medical Treatment.

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 Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC809 (FAS) - (06/04)

Page: 7 of 8

Document Has Been Signed on 12/05/2022 11:36 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: CONCORDIA ELEMENTARY	FACILITY NUMBER: 304270965
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101212(b)

Reporting Requirements

(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). 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. Sub Teacher S2 who is in charge during todays visit did not have a Designation of Responsibility form available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/19/2022
	Plan of Correction
1 2 3 4	Submit proof to LPA by POC due date.

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: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC809 (FAS) - (06/04)

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