304371483-4-28-2021-06-CC-KDEI-C2HSU3-20210428141029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371483
Report Date: 04/28/2021
Date Signed: 04/28/2021 02:10:45 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:	FAIRMONT SCHOOLS SAN JUAN CAPISTRANO		FACILITY NUMBER:	304371483
ADMINISTRATOR:	HUEBNER, TAMMY		FACILITY TYPE:	850
ADDRESS:	26333 OSO ROAD		TELEPHONE:	(949) 443-4050
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	132	CENSUS: 12	DATE:	04/28/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator Ms. Huebner Tammy & Ms. Jansen Kristen		TIME COMPLETED:	02:30 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	Licensing Program Analyst (LPA) Ms. Ketki Desai conducted an announced on site pre-licensing inspection at the childcare center. It is a Change of Ownership LPA met with Facility Director Ms. Huebner and Director of Education Ms. Kristen Jansen who gave a tour of the Child Care Center. The applicant has requested to provide care and supervision for 132 Pre-school age children 2 to 5 years of age, Monday through Friday 7.00 am. to 6.00 PM. in the assigned eight classrooms. A review of the Facility Personnel Report Summary on this date 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 facility is located on the campus of Fairmont Schools of San Juan Capistrano, upon entering the facility through the metal sliding door, given access by the Security personnel, make a left turn and the preschool area is located at the side end of the facility. There is a ramp and stairway leading to the preschool area near Room # 115 ( Office area). The eight assigned classrooms are in the hallway. Due to COVID Pandemic parents are not allowed inside, children are received at the entrance door by the staff, temperatures are checked, hands are sanitized before they are taken to their classrooms. Parents sign them in at the entrance electronically, currently outside visitors are not allowed in the facility. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the 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 (Page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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: FAIRMONT SCHOOLS SAN JUAN CAPISTRANO	FACILITY NUMBER: 304371483
	VISIT DATE: 04/28/2021

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Medication will be stored in Director's office in a locked cabinet and shall be administered by the teacher or the Facility in charge, emergency First Aid kits are stored in the classrooms and in the in assigned cabinets. Medication administration forms were reviewed.
Isolation area is the Director’s office and the sick child shall use the adult restroom located in the office area, there an additional mat and linens for the sick child.

The following were inspected in the indoor activity space:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through water fountains, pitchers as well as individual sports bottles if they prefer
· Sign in/Sign out procedure was reviewed and meets regulation requirements (electronic sign in and out)
· There is a working smoke detector, carbon monoxide detector and fire extinguisher that meet statutory requirements
· Cubbies available for storage of individual child’s personal belongings and/or bedding
· Napping equipment: Mats are used and are stored in the storage room in-between two classrooms, napping linens are provided by the facility.
· Facility shall provide two snacks and lunch is brought from home or purchased at the facility.

LPA discussed the posting requirements including, but limited to, the following:
· Facility License in public area (101160)
· Emergency Disaster Plan (LIC 610)
· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269)
· COVID Posters
(Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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: FAIRMONT SCHOOLS SAN JUAN CAPISTRANO	FACILITY NUMBER: 304371483
	VISIT DATE: 04/28/2021

NARRATIVE

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Facility has Eight preschool rooms and the measurements are as follows:

ROOM IDENTIFICATION	LENGTH	WIDTH	AREA	ENCUMBERED	SPACE
Room # 117	28.08	24	673.92		673.92
Room # 118	28.5	23.42	667.47		667.47
Room # 119	23.5	24.08	565.88	3.18	562.70
Room # 120	28.5	24	684.00	0.00	684.00
Room # 121	26.58	23.83	633.40	0.00	633.40
Room # 122	28.5	23.58	672.03	3.18	668.85
Room # 123	26.58	23.42	622.50		622.50
Room # 124	26.5	23.5	622.75	3.18	619.57

Total Indoor space: 5132’41 Divided by 35 = 146’64 (147 children)

Total sinks: 16 X 15= 240 (children) / Total Toilets: 9 X 15= 135 (children) There are two toilets in-between two classrooms and facility has designated one bathroom in the elementary school side which is at the end of the hallway, for Preschool children. While using this restroom, children shall be accompanied by the staff and they shall ensure there is no commingling with other elementary school age children.

LPA observed one sinks in all the classrooms. Toilets and sinks were observed to be age appropriate in all the bathrooms observed. Bathrooms were clean and accessible to children.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water fountains, water pitchers and personal water bottles.
· Outdoor activity space is supplied with age and size appropriate equipment, including climbing play structures and outdoor activity toys, Garden area with tables and a sand area
· An adequate amount of cushioning material consisting tire chips is in place under the play structures
· Adequate shade is provided by shaded roof surrounding the bike trail and benches are placed.
· There are two play yards designated for Preschool children. (Page-3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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: FAIRMONT SCHOOLS SAN JUAN CAPISTRANO	FACILITY NUMBER: 304371483
	VISIT DATE: 04/28/2021

NARRATIVE

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Outdoor space measurements:

Preschool yard	136	64.5	8772.00		8772.00
Preschool yard Garden area	49.5	25	1237.50		1237.50

Total Outdoor space: 10009’ divided by 75 = 133.46 ( 133 children)

Based on the indoor and outdoor measurements, sink and toilet availability, facility has enough space to accommodate 132 Preschool age children (age 2- 5y ears) in the assigned eights classroom

Fire clearance received from Orange County Fire Authority dated 4/21/21 have approved the requested capacity of 132 children in the eight assigned rooms.

Facility Administrator is current on the required Immunization/ Pediatric CPR/ First training valid through 1/6/23 and have provided the completion certificate for the Preventive Health training (Nutrition and Lead component)

Water Analysis not needed for the facility as the construction was completed in 2008.

LPA discussed with the applicant that all employees must have criminal record clearances associated to the facility prior to their presence in the facility, staff to child ratio requirements, direct visual supervision requirements, emergency/disaster drills, children records, mandated reporter training, and staff immunization requirements against measles, pertussis, and influenza. Applicant was advised the children's bedding must be stored individually and may not touch another children's bedding.

The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf (Page-4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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: FAIRMONT SCHOOLS SAN JUAN CAPISTRANO	FACILITY NUMBER: 304371483
	VISIT DATE: 04/28/2021

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Applicant was informed of Mandated Reporter Training for self and all assistants. Department web site form was given to down load forms, Title 22 regulations, and training's on-line at www.ccld.ca.gov. The applicant was also informed to visit the website for Quarterly Updates. The applicant was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov. or at www.ccld.ca.gov

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) were provided. The applicant/facility representative was informed, and website given, about the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the applicant/facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

The facility was following Title 22 requirements at the time of the inspection. Based on today’s measurements, and the sink and toilet availability, this center has enough activity space to support the capacity of 132 Preschool children in the assigned 8 classrooms. (Room # 117/ 118/ 119/ 120/121/122/123 and 124.
On the campus of Fairmont Schools of San Juan Capistrano.

A license will be issued for the capacity of 132 preschool children age 2-5 years old, after a final review. The applicant will be notified if any additional information is required.

(Page -5)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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: FAIRMONT SCHOOLS SAN JUAN CAPISTRANO	FACILITY NUMBER: 304371483
	VISIT DATE: 04/28/2021

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Applicant was also advised, once licensed, the Notice of Site Visit must be posted for 30 days and if A violations are cited then the Licensing Report (LIC809 or 9099) must be posted by the Notice of Site Visit for a period of 30 days or $100 civil penalties will be assessed, and the report shall posted and copies provided to the 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 and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file
Exit interview was conducted and a copy of this report was provided to the director on this date.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The applicant was provided a copy of their appeal rights (LIC 9058 12/15) 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

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

LIC809 (FAS) - (06/04)

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