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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371248
Report Date: 03/10/2020
Date Signed: 03/10/2020 10:29:34 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:MILESTONES MONTESSORI OF LAKE FORESTFACILITY NUMBER:
304371248
ADMINISTRATOR:PATOPOFF, JAMIEFACILITY TYPE:
830
ADDRESS:23222 LAKE CENTER DRIVETELEPHONE:
(949) 830-9999
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:24CENSUS: 13DATE:
03/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Jamie PatopoffTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Cindy Nguyen conducted a case management inspection to confirm the removal of a staff member at this facility. LPA and director toured the facility inside and outside. Census was taken in individual classrooms. The overall census observed was 13 infant children with 4 staff members. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Based on the evidence obtained during today’s visit, the LPA has verified the individual is not present, employed or residing at the facility. LPA has advised the licensee to disassociate the individual from their roster and submit an updated LIC 500.

The Director stated this staff member was never employed with the facility and has not been back to the facility since the interview.

Verification of removal is complete.

The report reviewed and exit interview was conducted with the Director, Jamie Patopoff. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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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