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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371125
Report Date: 08/14/2019
Date Signed: 08/14/2019 03:31:27 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:HERITAGE CHRISTIAN PRESCHOOLFACILITY NUMBER:
304371125
ADMINISTRATOR:BENEDETTO, SHARONFACILITY TYPE:
850
ADDRESS:22081 HIDALGOTELEPHONE:
(949) 598-9166
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:60CENSUS: 10DATE:
08/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:DirectorTIME COMPLETED:
04:00 PM
NARRATIVE
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An unannounced annual inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek who met with staff, Jennifer Gye Pes who was supervising napping children. The director, Sharon Benedetto and two other staff who were at lunch arrived during LPA's inspection. Census was taken and there were a total of 10 napping preschool children with one staff in one room. The other unused classrooms were also inspected.
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 except for Jennifer Gye Pes who started working at the facility since June 2019. An immediate civil penalty of 500.00 was assessed today for this violation.
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. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Two medium size slides with climbing structure was placed on synthetic grass . 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.
LPA reviewed Incidental Medical Services (IMS) with the director. There are currently no medication for children at the facility. When any IMS is provided, a Plan for Providing IMS must be submitted to the
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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: HERITAGE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371125
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/14/2019
Section Cited
CCR
101170(e)(2)
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Criminal Record Clearance. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. This section was not met as evidenced by not having staff's name in the
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The facility representative started faxing the paperwork to our office to associate the staff. LPA will check the computer system to confirm association of the staff later. An immediate civil penalty of 500.00 was assessed today.
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computer system verifying the association. clearance ID number in the Department's computer system but has not been associated to this facility. Jennifer Gye Pes has been working here since June 2019. The facility failed to send staff's association paperwork to our office. This is an immediate risk to the health and safety of children in care.
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The paperwork needs to be sent are:

LIC 9182 with clearance ID # on it
LIC 508
A copy of driver's license.
Fax # 714-703-2831
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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: HERITAGE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371125
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2019
Section Cited
CCR
101216(f)
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Personnel Requirement-At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or off site for center activities. This section was not
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The director stated they will have a training for all staff to get their CPR and 1st aid cards. The director agreed to send a copy of the cards to LPA by the due date of 9/28/2019
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met as evidenced by reviewing staffs' files today. LPA reviewed four available staffs' files and Non had current CPR and 1st aid cards. The facility failed to meet this section of regulations. This is a potential hazard to the health and safety of children in care.
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Type B
09/27/2019
Section Cited
HSC
1596.8662
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 On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete
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The director stated she would send copies of mandated reporter training certificates to our office. She will fix this deficiency by having the staff take the training and will email LPA Malek copies of the training by the due date of 9/27/2019.
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renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This was not met as evidenced by lacking these forms on staffs' files. LPA reviewed 4 staffs' files and Non had this requirement. Facility failed to meet the regulations. This poses a potential health and safety risk to the 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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 4 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: HERITAGE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 304371125
VISIT DATE: 08/14/2019
NARRATIVE
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Department. 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.
LPA has received the plan of operation for providing IMS to children in our office.

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. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates.
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 and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative today. An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the staff today.
In the areas that were evaluated, the facility was not in compliance of the California Code of Regulations, Title 22, Division 12.
The deficiencies were cited on LIC 809D dated 8/14/2019.

If the facility receives a Type 'A' violation the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

This report ends here.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4