304371120-3-10-2021-06-CC-STOE-BYYUAF-20210310142440

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371120
Report Date: 03/10/2021
Date Signed: 03/10/2021 02:24:49 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:	COMMUNITY CARE CLUB @ COMMUNITY ROOTS ACADEMY		FACILITY NUMBER:	304371120
ADMINISTRATOR:	WALTERS, MARIA FERNANDA		FACILITY TYPE:	840
ADDRESS:	29292 CROWN VALLEY PKWY		TELEPHONE:	(949) 831-4272
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	120	CENSUS: 36	DATE:	03/10/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maria Walters, Director		TIME COMPLETED:	02:04 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	On 03/10/2021, at 1:00 p.m., Licensing Program Analyst (LPA), Stacy Torrence conducted a virtual inspection with Maria Walters, Director. The purpose of this inspection is to provide technical assistance and ensure the facility is safe for the care and supervision of children in care. There were 36 children and 6 staff present. Due to COVID-19 state of emergency a waiver to allow the usage of rooms B1, B4, K1, K2, D3, and the library, not licensed by the Department, to accommodate the current class size restrictions as a precautionary measure with the COVID-91 outbreak, was granted on 07/13/2020, extended on 10/13/2020, 10/14/2020, and 01/14/2021, this waiver expired on 02/15/2021; however, a final extension was granted and the new expiration date is 04/16/2021. Fire clearance approval letter on file and dated 11/05/2020, granted on 12/15/2020. The facility will utilize the following classrooms for childcare: B1, B4, K1, K2, D3, and the library. Parents are not allowed inside the classrooms. Upon arrival, children’s temperatures are checked. Staff sign the children in only and the parents sign the children out. If children become ill during the day, they will rest in the isolation area located, in the director’s office. The children will use the bathroom, located next to the director’s office. There are multiple staff bathrooms located on the campus. Children’s authorized representative will be contacted immediately for pick up, if a child becomes ill. Department of Public Health will be contacted in regard to any COVID-19 illness. Children will stay with the same group as assigned and will not be moved from one group to the other. No more than 16 individuals in a cohort and groups must be kept physically separated. Age appropriate furniture including tables and chairs and are present in each of the rooms to meet the needs of children in care. There are 2 girls’ bathrooms and 2 boys’ bathrooms, with 3 toilets and 3 sinks in each. Each classroom also has a sink. There is a designated outdoor play area with age appropriate equipment and activities. Children bring their own water bottles from home, labeled with their names. If children need to re-fill their bottles, there is a water dispenser available.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2021

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: COMMUNITY CARE CLUB @ COMMUNITY ROOTS ACADEMY	FACILITY NUMBER: 304371120
	VISIT DATE: 03/10/2021

NARRATIVE

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The facility will maintain children files that include emergency authorization cards and staff files that include proof of criminal background clearance. All childcare areas, including the playgrounds, will be cleaned and sanitized daily or more often as necessary following the facility’s cleaning and sanitation policies,

A health check on staff and children will be conducted each day upon arrival. LPA discussed the terms and conditions of the waiver and facility will ensure compliance with all terms and conditions of the Temporary Waiver and will adhere to Public Health guidelines and directives.

To further ensure the health and safety of the children in care, Community Care Licensing will provide on-going Technical Assistance (TA) to the facility.

Please feel free to contact the Orange County Child Care Office at (714) 703-2800.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2021

LIC809 (FAS) - (06/04)

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