304371120-8-26-2021-06-CC-STOE-C69QPD-20210826122034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371120
Report Date: 08/26/2021
Date Signed: 08/26/2021 12:20:41 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: 0	DATE:	08/26/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Maria Walters, Program Director		TIME COMPLETED:	12:30 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	An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Stacy Torrence for the purpose of adding six classrooms. The facility is currently licensed for 120 and is not requesting a capacity change. The facility is located inside the Community Roots Academy, which is owned by the Capistrano Unified School District. LPA Torrence met with Maria Walters, Program Director, who guided analyst on a tour of the facility. The facility was not in session at the time of the inspection. The program operations hours are as follows: Monday, Tuesday, Thursday, and Friday; 6:30 a.m.-8:00 a.m. and 3:00p.m.-6:00p.m., and Wednesday; 6: 30a.m-8:00a.m. and 12:30p.m.-6:00p.m., Holiday and Summer Breaks operation hours are: 6:30a.m.-6:00p.m.; serving children ages 4.9-14 years old. In classrooms: B1, B4, B6, Library (D1), D3, D5, D6, K1, K2, and PAC. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. All areas identified on the Facility Sketch were inspected. 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. Medication is stored in the director’s office in a locked cabinet. Furniture and equipment were inspected for age appropriateness and good repair. Age appropriate sinks and toilets were inspected for availability and good repair. Drinking water is available indoor/outdoor by the children bringing their own water bottles from home, labeled with their names. If children need to re-fill their bottles, there is a water dispenser available. First Aid supplies were inventoried. Sign in / sign out record meets regulation requirements. The facility provides PM snacks only. Continue on next page ( 1 of 2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: 08/26/2021

NARRATIVE

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Indoor Activity Space Measurements:
Classroom #B1: 29.08 x 29.02= 843 sqft.
Classroom #B4: 29.07 x 29.02= 843 sqft.
Classroom #K1: 39.01 x 29.02= 1,132 sqft.
Classroom #K2: 39.01 x 27.01= 1,053 sqft.
Classroom #D3: 31.04 x 29.02= 900 sqft
Classroom #D1: 49.00 x 29.06= 1,423 sqft.
Total= 6,194 sqft. divided by 35 = 176 children

Total children toilets and sinks:
Toilets: 15 x 15 = 225 children
Sinks: 13 x 15 = 195 children

Outdoor Activity Space Measurements:
Outside activity space was measured for 50000 square feet, accommodates 666 children. Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure. An adequate amount of cushioning material is in place under the equipment. Shade is provided by a patio cover.

Fire clearance approval letter on file and dated 08/10/2021, adding rooms B1, B4, K1, K2, Library(D1), and D3

Facility provides Incidental Medical services.

In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.

A license will be issued for the capacity of 120 with the additional classrooms.

Exit interview was conducted. A copy of this report and appeal rights were discussed and provided to the director. The Notice of Site Visit was posted. The director 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.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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