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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370700
Report Date: 06/17/2020
Date Signed: 06/17/2020 12:35:51 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:STONEYBROOKE CHRISTIAN PRE-SCHOOLFACILITY NUMBER:
304370700
ADMINISTRATOR:BRUCKER, JAMIEFACILITY TYPE:
850
ADDRESS:26300 VIA ESCOLARTELEPHONE:
(949) 364-4407
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92692
CAPACITY:60CENSUS: 0DATE:
06/17/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director Jamie Brucker TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA’s) Ketki Desai conducted an on site Case Management -Licensee initiated (Capacity increase) inspection at this child care center. LPA met with Administrator Brucker Jamie and toured the site. The Licensee has requested to provide care and supervision for Pre-school age children 2.9 to 6 years of age, Monday through Thursday 8.00 a.m. to 3.00 p.m. and on Fridays from 8.00 am to 2.00 pm. review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

There were no children present for the preschool program. LPA toured the facility inside and outside. Currently the campus is closed.

The children shall have access through the main entrance of the center, the classrooms are first level and the second level. Each floor has three classrooms which were measured today.

Policy for Incidental Medical Services – IMS was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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

Incidental Medication will be stored in each classroom in a locked mental box, including the authorization documentation and shall be administered by the teacher. Medication administration forms were reviewed.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
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 4
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: STONEYBROOKE CHRISTIAN PRE-SCHOOL
FACILITY NUMBER: 304370700
VISIT DATE: 06/17/2020
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The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age appropriate furniture and equipment
· Drinking water is available inside through water fountain as well as individual sports bottles
· Sign in/Sign out procedure was reviewed and meets regulation requirements (electronic sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment shall be stored in storage area located in the hallway , they are stored in their individual zip lock bags . Mats are used during nap time, linens are brought from home

Facility policy is that lunches/ snacks are provided by the parents, and if needed center has additional snacks.

Facility meets the posting requirements, which are posted in the hallway.

The indoor activity space was measured and is as follows:
(Top Floor)
Room #1: 27..67 x 23.92 = 661.87
Room # 2: 27.58 x 23.92= 659.71
Room # 3: 29.83 x 21.83= 651.19
(Bottom Floor)
Room # 4 : 23.75 x 23.92 ( next to storage)
Room # 5: 27.42 x 23.92
Room # 6: 17 x 6.08 (Small rectangle – front of desk)
24.17x 17.17 (Big rectangle)

7 sinks x 15= 105 children
8 Toilet x 15 children= 120

The indoor activity area measured and findings are as follows
3445.08 divided by 35 = 98.43
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: STONEYBROOKE CHRISTIAN PRE-SCHOOL
FACILITY NUMBER: 304370700
VISIT DATE: 06/17/2020
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The outside activity area :
Play yard 1 and play yard 2 are downstairs and shared playground with elementary children are on the first level. Along with one play yard next to the elementary yard, which is completely fenced with age appropriate play equipment's on the top level next to the field.

Fire clearance approved the requested capacity (75)

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. Applicant/facility representative was advised the children's bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by fountain, individual sports bottles
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor scooters
· An adequate amount of cushioning material consisting of rubber form is in place under the play structures
· Adequate shade is provided by canvas canopy on top of play structures)

Director Jamie Brucker is current on the required CPR/ First Aid certification, valid through August 27th 2020 and Mandated Reported training was taken in January 2020.


Licensee was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: STONEYBROOKE CHRISTIAN PRE-SCHOOL
FACILITY NUMBER: 304370700
VISIT DATE: 06/17/2020
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Facility representative was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The facility representative was also informed to visit the website for Quarterly Updates.

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 applicant/facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness

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 75 (Preschool children). A license will be issued for the capacity requested after a final review. The applicant will be notified if any additional information is required.

Licensee was given a copy of Notice of Site Visit, along with Appeal rights. which must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) 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
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4