304371495-6-1-2021-06-CC-KDEI-C3KRXV-20210601132523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371495
Report Date: 06/01/2021
Date Signed: 06/01/2021 01:25:35 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:	LEPORT MONTESSORI SCHOOL WESTPARK		FACILITY NUMBER:	304371495
ADMINISTRATOR:	RIVAS, ANA		FACILITY TYPE:	830
ADDRESS:	1055 SAN MARINO		TELEPHONE:	(949) 833-8474
CITY:	IRVINE	STATE: CA	ZIP CODE:	92614
CAPACITY:	12	CENSUS: 0	DATE:	06/01/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator: Ms.Rivas, Ana		TIME COMPLETED:	01:45 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) Ketki Desai conducted an on-site pre licensing inspection at this proposed Infant care center. Licensee also has a preschool license with Toddler option (304371211) on the same premises. LPA met with Facility Administrator Ms Rivas, Ana and toured the new Infant classroom # 5 only. The applicant has requested to provide care and supervision for 12 infant children, 3 months through 24 months old , Monday through Friday, 7.00 am. to 6.00 PM. 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 Infant classroom is designated in Room # 5 . The Infant room has its entrance door in the hallway, across room # 3 and 4. Applicant has posted all the Licensing posting and the required COVID Posters on the Bulletin board, in the lobby area where infants shall be received, temperatures shall be checked upon arrival for the infant by the staff member. 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. IMS medications are stored in the Emergency Bags in the classrooms and staff members have received the required training. Director's office is the Isolation area. (Page-1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

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: LEPORT MONTESSORI SCHOOL WESTPARK	FACILITY NUMBER: 304371495
	VISIT DATE: 06/01/2021

NARRATIVE

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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 by water pitchers
· 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 shall be stored in individual cubbies when not in use
· The changing table is within arm’s reach of a sink
· The changing table is padded with raised sides (Koala brand installed in the bathroom)
· Bedding will be taken home daily by the parents and extra beddings if needed is available.
· There is a designated napping room with sufficient infant napping equipment (3 cribs and cots for older infants)
· The infant indoor area is physically separate from the preschool component

Center policy is that formula/ baby food/ Diapers/ pull ups/ lotions / wipes/ crib linens/ personal utensils/ bowls are to be provided by the parents, every infant shall have their own bin to store personal items.
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)
· Sudden Infant Death Syndrome Poster
· Shaken Baby Syndrome Poste r (Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

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: LEPORT MONTESSORI SCHOOL WESTPARK	FACILITY NUMBER: 304371495
	VISIT DATE: 06/01/2021

NARRATIVE

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The indoor activity space was measured and is as follows: Infant rooms

Room # 5 (Infant room) : 30.08 X 22.42 = 674.39 - 204.29 (Encumbered: Napping/Kitchen counter/ Refrigerator) = 671.96

Total Indoor activity space: 671.96 divided by 35 = 19.20 ( 19 infants)

Total children toilets and sinks: (2 sinks and 2 toilet and 1 potty chairs shall be used) Sink : 2 x15= 30 infants

LPA discussed with the applicant/facility representative 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/facility representative was advised the infant crib area must be supervised at all times. No infant should be left unattended in the crib area. bedding must be stored individually and may not touch another children's bedding.

The following were inspected in the outdoor activity space;
· Playground is fully enclosed by an appropriate fencing
· Drinking water is available outdoors by water pitchers
· Outdoor activity space is supplied with age and size appropriate equipment,
· An adequate amount of cushioning material consisting of softcrete placed under the toys
· Adequate shade is provided by completed shaded structure.
Infant yard is accessed through hallway exit door and it shall be shared with the Toddler component, this yard is also used by one Preschool classroom (age 2-3 years old). Waiver is in place.

Total outdoor activity space was measure and is as follows:
Infant/ Toddler yard: 75.33 X 42.33 = 3188.72 = 42 .52 (42 children)

Applicant shall request a Waiver for Outdoor staggered schedule with Toddler option.
( Page-3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

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: LEPORT MONTESSORI SCHOOL WESTPARK	FACILITY NUMBER: 304371495
	VISIT DATE: 06/01/2021

NARRATIVE

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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

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/facility representative 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
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
(Page-4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: LEPORT MONTESSORI SCHOOL WESTPARK	FACILITY NUMBER: 304371495
	VISIT DATE: 06/01/2021

NARRATIVE

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· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold.

The facility was in compliance with Title 22 requirements at the time of the inspection.

A copy of PIN 20-24 was also provided to the applicant.

Based on today’s measurements, and the sink and toilet availability, this center does has sufficient Indoor activity space to support the requested capacity for 12 infants.

A license will be issued for the capacity of 12 Infants ( 3 months - 24 months) in Room # 5 , after a final review. Applicant shall be notified if additional information is needed.

Approval from Orange county Fire Authority has been received for the requested capacity.

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

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: 06/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021

LIC809 (FAS) - (06/04)

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