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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370212
Report Date: 06/28/2019
Date Signed: 06/28/2019 12:23:20 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:FULBRIGHT MONTESSORI ACADEMYFACILITY NUMBER:
304370212
ADMINISTRATOR:BERGMAN, JULIEFACILITY TYPE:
850
ADDRESS:20411 JAMES BAY CIRCLETELEPHONE:
(949) 583-9292
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:98CENSUS: 83DATE:
06/28/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director, Julie BergmanTIME COMPLETED:
01:00 PM
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An unannounced Random/Annual visit was conducted today by Licensing Program Analyst (LPA) Nguyen. The facility file was reviewed prior to this inspection. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance. Operating hours are 7:00am to 6:00pm, Mon-Fri. Upon arrival LPA met with Director, Julie Bergman. LPA observed 83 preschool age children with 10 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

The facility was toured inside and outside and the floor and yard plan were verified. The facility representative stated there is no bodies of water onsite. LPA confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly. The items which could pose a danger to children (disinfectants and cleaning solutions) were stored out of the reach of children. Poisons/Hazardous Items are locked in storage room. All materials and surfaces accessible to children are toxic free. Medications are in a safe place inaccessible to children. The children’s bathrooms were observed to be in safe and sanitary operating conditions.

All floors are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Food is not prepared on site, lunches and snacks are provided only as needed. Solid waste receptacles have a tight-fitting cover and are in good repair. Children nap on cots/mats, and bedding is sent home weekly to be laundered by parents.

There is drinking water available to children both indoors and outdoors. A suggested menu is posted in each classroom. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher that meet statutory requirements.
Continued on Page 2
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019
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 3
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: FULBRIGHT MONTESSORI ACADEMY
FACILITY NUMBER: 304370212
VISIT DATE: 06/28/2019
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The playground was completely fenced. The playground equipment appeared in safe condition, and play area is free from hazards. There is sufficient foam cushioning underneath climbing structures and/or play equipment to absorb falls. The facility has conducted an emergency drill within the past six months.

Sign in/out procedure was reviewed for compliance. This facility utilizes electronic sign in/out system. A random sample of children’s sign/in out sheets for two dates was reviewed. The person who signs the child in and out uses thumbprint and the time of the day is recorded by the system. The director stated there is a separate, complete, and current record maintained for each child enrolled in the child care center. A random sample of ten children’s files were reviewed and found to be in substantial compliance.

Staff files for staff present during today’s inspection were reviewed for appropriate documentation of education credits. At least one staff member present possesses current CPR/First Aid certifications, which expires 8/30/19. Proof of immunization's against influenza (or written decline), pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. Proof of completion as required by AB 1207 was observed in staff files.

This facility provides Incidental Medical Services -IMS. LPA reviewed storage of medication, 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. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Facility representative was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov Continued on Page 3

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FULBRIGHT MONTESSORI ACADEMY
FACILITY NUMBER: 304370212
VISIT DATE: 06/28/2019
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In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative 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: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3