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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610674
Report Date: 03/06/2024
Date Signed: 03/06/2024 11:00:37 AM

Document Has Been Signed on 03/06/2024 11:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CAPISTRANO USD/LAS PALMAS STATE PRESCHOOLFACILITY NUMBER:
300610674
ADMINISTRATOR:VARGAS, ESTRELLAFACILITY TYPE:
850
ADDRESS:1101 CALLE PUENTE, #13TELEPHONE:
(949) 492-3456
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 14DATE:
03/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Estela Beas, TeacherTIME COMPLETED:
11:30 AM
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Licensing Program Analyst, (LPA) P Rivas conducted an unannounced case management visit in order to measure the rooms used for the preschool as the facility requested a decrease in capacity to 16 children.
Upon entrance into room #14, LPA viewed 14 children and two teachers.

The facility is operating two half day sessions from 8:00am to 11:00am and 12:00 to 3:00pm. The hours of operation are from 7:30 am to 4:00pm.

The preschool is operating under Title 5 and staff are exempt from fingerprint clearances as they are fingerprinted through the school district.

LPA took measurements in Room fourteen for a total square footage of 900 square feet. The outside activity space measured at 9896 square feet; There are two outdoor play areas that are totally enclosed by a chain link fence which is over 4 feet tall.

All indoor and outdoor activity space utilized for the children was inspected today. LPA informed Ms. Beas that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. There are : 4 toilets and 2 sinks in girls restroom; one toilet and three urinals and 2 sinks in boys bathroom. There is one sink in the classroom.
There is sufficient indoor and outdoor activity space, sinks, bathrooms for the capacity requested.

There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is adequate cushioning in fall zones of slides provided by cushioned foam . Drinking water is available via the children bring their bottled water outside.

Applicant/ Licensee Ms. Breas was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CAPISTRANO USD/LAS PALMAS STATE PRESCHOOL
FACILITY NUMBER: 300610674
VISIT DATE: 03/06/2024
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care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans does provides Incidental Medicals Services and Plan.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. “



The following is required prior to decrease in capacity;
1. Designation of administrative responsibility for director.
2 Emergency Care and Disaster plan lic 610 (updated)
3. Any changes to parent hand book or admission agreement. If no changes a statement stating there are no changes.
4. A final review of application packet

Items to be provided by 04/06/34.

A capacity decrease to 16 may be granted after the above requirements are met and a final file review is conducted.

A notice of site visit was given to Ms. Beas and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days

Exit interview was conducted and report was reviewed with the licensee's designee Ms. Beas.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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