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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370917
Report Date: 08/22/2019
Date Signed: 08/22/2019 01:25:02 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:BOUSD-MARIPOSA EARLY LEARNING CENTERFACILITY NUMBER:
304370917
ADMINISTRATOR:CORDOVA-PEREZ, ANGELICAFACILITY TYPE:
850
ADDRESS:1111 WEST MARIPOSA DRIVETELEPHONE:
(714) 990-7536
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:24CENSUS: 14DATE:
08/22/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Ian Young, Site SupervisorTIME COMPLETED:
01:30 PM
NARRATIVE
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An unannounced inspection was conducted by the Licensing Program Analyst (LPA) Torrence on 08/22/2019 at 10:35 a.m. Licensing Program Analyst (LPA), Torrence met with Site Coordinator, Ian Young and Supervisor Meredith White. Census was taken. There were 14 children present and two staff supervising. LPA Torrence toured the Early Childhood Setting indoors and outdoors. This program operates Monday - Friday 7:00 AM-6:00 PM, serving children ages 3 to 4 years of age, located on the Mariposa Elementary School site in portables G1. The facility has current waiver to share playground with the kindergarten children on a rotating schedule. 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 it's 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. Napping equipment was appropriate, and bedding is sent home every Friday for cleaning and brought back every Monday. Uncontaminated drinking water was readily available both indoors and outdoors. This facility provides PM snack, AM snack and lunch are provided by the parents. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (MMR, Pertussis, and Flu vaccines). The current director was hired on August 19th; however, her designated director paperwork was not sent to licensing for review and approval. Staff 3 did not have education verification and immunization requirements. Facility does not have a current disaster drill log. Facility have a current children's roster available. Fire extinguisher and carbon monoxide was located at this facility. A sample of children's files were reviewed.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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 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: BOUSD-MARIPOSA EARLY LEARNING CENTER
FACILITY NUMBER: 304370917
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2019
Section Cited

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101212(b) Reporting Requirements. 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).
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The requirement is not met as evidence by, the facility hired the current director on August 19th and did not informed the licensing department. This poses a potential risk to the safety of children in care.
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Type B
08/23/2019
Section Cited

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101216(b)(1)Teacher Qualifications and Duties. Prior to employment, a teacher shall meet the requirements. A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement... The requirement is not met
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as evidence by record review of Staff 3. Staff 3 was missing proof of education verification. This poses a potential risk to the safety of children in care.
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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 LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2019
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: BOUSD-MARIPOSA EARLY LEARNING CENTER
FACILITY NUMBER: 304370917
VISIT DATE: 08/22/2019
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The Incidental Medical Services-IMS was discussed. 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.htmThe updated plan of operation has been received in our office for providing Incidental Medical Services. (IMS)

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov . Staff 1 and 2 completed the incorrect Mandated Reporter Training. Website provided: http://mandatedreporterca.com/.Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov



During this inspection, LPA observed the following deficiencies and are being cited in accordance with California Code of Regulations, Title 22, Division 12 & Chapter number 1, Article 6, 101212(b) Reporting Requirements and 101216.1(b) Teachers Qualifications and Duties, and H&S 1596.7995 Immunization are being cited on the attached LIC 9099D. A Technical Assistant Advisory Note for 101174(d) Disaster and Mass Casualty Plan and Technical Violation Advisory Note H&S 1596.8662 Mandated Reporter Training.

Exit interview was conducted. Report reviewed and discussed. The 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 $100.00. Notice of Site Visit was posted during the visit. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.


The following updated forms are to be sent to licensing:
LIC 500
LIC 308
Disaster Plan
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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: BOUSD-MARIPOSA EARLY LEARNING CENTER
FACILITY NUMBER: 304370917
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2019
Section Cited

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H&S 1596.7995 Employees or volunteers at day care center; immunization requirements; records; exemptions . The requirement is not met as evidence by record review of Staff 3. Staff 3 is missing proof of immunization for Pertussis, Measles, and Influenza. This poses a potential risk to the health of children in care.
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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 LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4