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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371085
Report Date: 05/15/2019
Date Signed: 05/15/2019 12:16:43 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:MISSION HILLS CHRISTIAN SCHOOLFACILITY NUMBER:
304371085
ADMINISTRATOR:FAULKNER, LINDAFACILITY TYPE:
850
ADDRESS:29582 AVENTURATELEPHONE:
(949) 589-4504
CITY:RANCHO STA MARGARITASTATE: CAZIP CODE:
92688
CAPACITY:40CENSUS: 32DATE:
05/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:DirectorTIME COMPLETED:
12:45 PM
NARRATIVE
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An unannounced Annual Random inspection was conducted today by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek who met with director, Linda Faulkner in classroom 405. Census was taken. There were a total of 35 preschool children with 5 staff including the director in 3 different classrooms. The classrooms were inspected. (401, 405, and 406). 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 was 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. The food preparation area was inspected for cleanliness, free of rodents/vermin, appropriate storage of food, and verification of posted menus. There are no weapons, firearms or bodies of water in the facility observed. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. There were adequate cushioning was observed. 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.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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: MISSION HILLS CHRISTIAN SCHOOL
FACILITY NUMBER: 304371085
VISIT DATE: 05/15/2019
NARRATIVE
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Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. http:/www.ada.gov/childqanda.htm

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 informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates.


Appeal Rights were discussed. The facility representative 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. First level appeal is to Regional Manager, address is above on the report. The director was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC 9182) and a picture ID for all the associations Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

A copy of child care provider's guide to safe sleep pamphlet was given to the applicant.
A copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org was given to the director on the last inspection. 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 deficiency was cited. Please see LIC 809D section 102226(e)(A) for the medication which was expired in January 2019.

This report ends here.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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: MISSION HILLS CHRISTIAN SCHOOL
FACILITY NUMBER: 304371085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
101226(e)(A)
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Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. The medication for one child was expired on January 2019. This requirement was not met as evidenced by reviewing the medication box for children.
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The director will send a copy of correction to our office. The medication shall be refilled with a valid date.
A picture of the medication with a valid date with the child's name shall be sent to LPA. This can be done via email to LPA.
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The facility failed to meet the regulations for this section. This is a potential risk to the health of children.
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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: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
LIC809 (FAS) - (06/04)
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