304370910-7-11-2019-06-CC-MMAK-BDYUAH-20190711152445

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370910
Report Date: 07/11/2019
Date Signed: 07/11/2019 03:24:50 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:	SAN JUAN MONTESSORI		FACILITY NUMBER:	304370910
ADMINISTRATOR:	SHARAN, SANDHYA		FACILITY TYPE:	850
ADDRESS:	32143 ALIPAZ STREET		TELEPHONE:	(949) 496-2927
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	45	CENSUS: 36	DATE:	07/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Staff in charge		TIME COMPLETED:	11:45 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	Page 1 An unannounced Annual inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek who met with staff in charge, Janet Corpin. The director, Sandhya Sharan arrived later during LPA's inspection. Census was taken. There were a total of 36 preschool children with 4 staff in three different classrooms. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture were inspected to ensure they are in good condition, free of sharp, loose or pointed parts. Toilets and sinks were inspected to ensure they are safe and in a sanitary operating condition, floors were inspected for safety and cleanliness. The food preparation area was inspected for cleanliness, free of rodents/vermin, appropriate storage of food, and verification of posted menus. (At this facility parents provide snack and lunch for their children). There are no weapons, firearms or bodies of water in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (MMR, Pertussis, and Flu vaccines. A sample of children's files were reviewed for completeness of admission agreement, verification of sign in/out including time the child was signed in/out by authorized representative as well as verification of representatives full legal signature. Incidental Medical Services (IMS) was discussed with the director. For IMS information see Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173. Continued on page 2

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

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: SAN JUAN MONTESSORI	FACILITY NUMBER: 304370910
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/11/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/18/2019 Section Cited CCR 101238.2(e)	1 2 3 4 5 6 7	101238.2(e) Outdoor Activity Space. As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. This requirement is not met as evidenced by LPA's observation lacking cushioning the slide and climbing structure/slide in the front	1 2 3 4 5 6 7	The director stated she would remove this equipment from the front playground in September. She stated the staff would be instructed not to let the children to use the equipment until is removed. The director stated she would buy a new equipment with proper cushioning after removing this equipment form the front yard.
	8 9 10 11 12 13 14	playground which were placed on concrete surface. There are few rubber mats under the equipment which are not adequate cushioning. Licensee failed to meet this regulation. This poses a potential risk to the safety of children in care.	8 9 10 11 12 13 14	The front yard is for use of younger children (2 years old). This deficiency had been cited on 5/30/2018. The director will send a letter of correction to our office by 7/18/2019.
Type B 07/25/2019 Section Cited CCR 101220(a)	1 2 3 4 5 6 7	101220(a) Child's Medical Assessment- Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health related to the	1 2 3 4 5 6 7	The director stated she would ask the children's parent to send a copy of physician report to her. The director will send copies to our office by the due date of 7/25/19.
	8 9 10 11 12 13 14	child. This requirement was not met as evidenced by reviewing children's files. On today's inspection 6 children's files were reviewed. Five children did not have the above requirements. Licensee failed to meet the above regulation. This is a potential risk to the health of children in care.	8 9 10 11 12 13 14

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

LIC809 (FAS) - (06/04)

Page: 3 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: SAN JUAN MONTESSORI	FACILITY NUMBER: 304370910
	VISIT DATE: 07/11/2019

NARRATIVE

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and 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 Notice of Site Visit was posted. 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. The licensee was provided a copy of their appeal right (LIC 9058 1/16) 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. First level appeal is to Regional Manager, address is above on the report. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov During this visit, LPA signed up the facility's email address to receive the quarterly updates and notification from our Department.
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the director today.

In the areas that were evaluated, the facility was not in compliance of the California Code of Regulations, Title 22, Division 12.
The following deficiencies were cited
CA code of regulation section 101238.2(e) for outdoor space lacking adequate cushioning under and around the climbing structure/slide and swings.
CA Code of Regulations section 101220(a) for four children lacking medical assessment on file (Physician Report).

This report ends here.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

LIC809 (FAS) - (06/04)

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