304371226-8-22-2019-06-CC-MMAK-BFANGD-20190822102658

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371226
Report Date: 08/22/2019
Date Signed: 08/22/2019 10:27:09 AM

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:	ESENCIA ELEMENTARY SCHOOL		FACILITY NUMBER:	304371226
ADMINISTRATOR:	JORDAN, VIVYANA		FACILITY TYPE:	850
ADDRESS:	5 APRENDER STREET		TELEPHONE:	(949) 234-5341
CITY:	RANCHO MISSION VIEJO	STATE: CA	ZIP CODE:	92694
CAPACITY:	48	CENSUS: 38	DATE:	08/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Site supervisor		TIME COMPLETED:	10:45 AM

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	Pg1 An unannounced annual inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek who met with site supervisor, Vivyana Jordan in room C102. The two classrooms are located on Esencia Elementary Public School ground. The facility has also requested to move from B101 and B102 rooms to C101 and 102 rooms. LPA has received the fire clearance approval for these two new rooms. Today is the first day for these present children. Census was taken and there were a total of 38 preschool children with 5 other staff in two classrooms observed. Classrooms C101 and C102 were measured. It is approximately 1680 square feet which accommodate 48 children in both rooms. Each individual classroom has a sink. There are two toilets on the playground for children's use. Also there are Boy's bathrooms with 2 sinks, 2 stalls, and 2 urinals, and Girl's bathroom with 2 sinks and 3 stalls close by to these two new classrooms. An updated waiver request will be sent to our office. 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 staff are employed by School District and are exempt from fingerprinting). 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. (The facility has a waiver approval to share the playground with TK children from this elementary site. Staff's files were reviewed for education verification, CPR/First Aid, and new immunization requirements for (MMR, Pertussis, and Flu Continued on page 2

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
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)

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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: ESENCIA ELEMENTARY SCHOOL	FACILITY NUMBER: 304371226
	VISIT DATE: 08/22/2019

NARRATIVE

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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.
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)514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/child qanda.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 provided a copy of their appeal right (LIC 9058 01/2016) 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. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates. Exit interview was conducted.

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 on the previous inspection. An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the site supervisor today.

An updated waiver request will be needed to use the new restrooms.

In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12. No deficiency was cited.

An updated license for the new rooms C101 and C102 is issued today and will be mailed out to the facility.
This report ends here.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
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)

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