304370212-1-7-2020-06-CC-CNGN-BKLQN4-20200107111832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370212
Report Date: 01/07/2020
Date Signed: 01/07/2020 11:18:42 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:	FULBRIGHT MONTESSORI ACADEMY		FACILITY NUMBER:	304370212
ADMINISTRATOR:	BERGMAN, JULIE		FACILITY TYPE:	850
ADDRESS:	20411 JAMES BAY CIRCLE		TELEPHONE:	(949) 583-9292
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	98	CENSUS: 88	DATE:	01/07/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Director, Julie Bergman		TIME COMPLETED:	11:50 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	Licensing Program Analysts (LPA) Cindy Nguyen conducted an inspection at the facility for the purpose of a capacity increase. The applicant has requested to care for 110 preschool age children ages 2 years to 6 years of age 7:00 AM to 6:00 PM, Monday through Friday. This facility is currently licensed for 98 children and has requested to increase by 12 children for a total capacity of 110 by adding Room 7. LPA met with Director, Julie Bergman and toured the facility. LPA observed 88 preschool children 11 staff members. During today's inspection it was determined the facility was operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary 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. LPA toured the entire facility indoors and outdoors and the following measurements were taken: The indoor activity space was measured and is as follows: Room #2: 963.7 sqft (previously measured on 1/11/06) Room #3: 1033.5 sqft (previously measured on 1/11/06) Room #4: 1036.6 sqft (previously measured on 1/11/06) Room #5: 653.0 sqft (previously measured on 1/11/06) Room #6: 922.4 sqft (previously measured on 1/11/06) Room #7: 695.0 sqft Total: 5304.2 sqft divided by 35 = 151 children Total children toilets and sinks: Toilets: 10 X 15 = 150 children Sinks: 9 X 15 = 135 children Continued on Page 2

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020

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: FULBRIGHT MONTESSORI ACADEMY	FACILITY NUMBER: 304370212
	VISIT DATE: 01/07/2020

NARRATIVE

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Total outdoor activity space was measure and is as follows:
Yard: 7135 sqft
Gym: 1350 sqft (previously measured on 1/11/06)
Total: 8,485 sqft divided by 75 = 113 children

Fire clearance from Orange County Fire Department has been received and approved for requested capacity of 110 children.

The following was observed:
· Classroom are adequately equipped with age and size appropriate furniture and equipment.
· Drinking water is available for inside and outside drink.
· Playground is fully enclosed by an appropriate fence.
· Outdoor activity area is supplied with age and size appropriate equipment.
· Shade is provided trees and shade structures.
· Snacks are provided by the facility and lunch is brought by each child or provided by the facility if the child does not bring their lunch.
· The office will serve as the isolation area for ill children until parents arrive.
· A separate staff restroom is available.
· Medication will be stored in each classroom and the office inaccessible to children in care.
· Sign in/Sign out procedure was reviewed and meets regulation requirements. This facility utilizes an electronic sign in/out system.
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements.

LPA discussed with the facility representative that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Facility representative was advised the children's bedding must be stored individually and may not touch another children's bedding.
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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020

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: FULBRIGHT MONTESSORI ACADEMY	FACILITY NUMBER: 304370212
	VISIT DATE: 01/07/2020

NARRATIVE

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

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

The facility was in compliance with Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has sufficient activity space to support the capacity of 110. A license will be issued for the capacity of 110 after a final review. The facility representative will be notified if any additional information is required.

Exit interview was conducted with Director, Julie Bergman & Licensee, Maria Houlihan. 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 Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy Nguyen	TELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020

LIC809 (FAS) - (06/04)

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