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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614189
Report Date: 09/06/2022
Date Signed: 09/06/2022 01:21:26 PM

Document Has Been Signed on 09/06/2022 01:21 PM - It Cannot Be Edited

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:ST. JOACHIM SCHOOLFACILITY NUMBER:
300614189
ADMINISTRATOR:JEANMARIE RAMETTAFACILITY TYPE:
850
ADDRESS:1964 ORANGETELEPHONE:
(949) 574-7411
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 5DATE:
09/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Debbie Barber, TeacherTIME COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs),Mila Quinto and Patricia Duron conducted an onsite inspection for the purpose of an Annual Random. LPA and staff toured the facility inside and outside and the floor and yard plan were verified. Census was taken and the overall observed were 5 preschool children and 1 staff. Due to COVID 19 guidelines, LPA observed staff and children following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 8a.m.- 1:30 p.m., Monday through Friday.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have not received criminal record and child abuse index clearances or exemptions. At 9:35am, LPAs observed 1 staff, Jennifer Luna does not have criminal background clearance.

During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Children bring their own snack and lunch. Food is properly stored. Floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges. There is drinking water available to children indoors by sports bottle with the child’s name on it. The children's bathrooms are clean and sanitary. Children nap on mats. LPAs observed the 5 children napping on cots without sheet cover. The facility has conducted an emergency drill within the past six months. The facility has a working fire extinguisher; however, the facility does not have carbon monoxide. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 09/06/2022 01:21 PM - It Cannot Be Edited


Created By: Mila Quinto On 09/06/2022 at 12:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(d)
Criminal Record Clearance
(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the facility did not comply with the section cited above. 1 of 2 staff present did not have fingerprint clearance which poses an immediate health, safety or personal rights risk to children in care.
POC Due Date: 09/06/2022
Plan of Correction
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Staff, Debbie Barber will have Jennifer Luna obtain fingerprint prior to returning to the facilty.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/06/2022 01:21 PM - It Cannot Be Edited


Created By: Mila Quinto On 09/06/2022 at 12:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observationand interview, the facility did not comply with the section cited above. There was no carbon monoxide in the facility. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/07/2022
Plan of Correction
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Staff wil make sure to have carbon monoxide installed in the facility by due date and will provide proof of correction via email to LPA, Quinto at mila.quinto@dss.ca.gov
Type B
Section Cited
CCR
101239.1(c)
Napping Equipment
(c) Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the facility did not comply with the section cited above. The 5 children in care did not have a sheet cover on the cots which which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/07/2022
Plan of Correction
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Staff will ensure to have cover sheet for each child to cover cots during rest time and will provide proof via email to LPA, Quinto at mila.quinto@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 09/06/2022 01:21 PM - It Cannot Be Edited


Created By: Mila Quinto On 09/06/2022 at 12:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(f)(1)
Fixtures, Furniture, Equipment and Supplies
(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPAs observed a trash bin without cover at the front entrance where childre use to throw their waste. This poses a potential health rights risk to children in care.
POC Due Date: 09/07/2022
Plan of Correction
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The facility will remove the trash bin without a lid and make it inaccessible to children.
Type B
Section Cited
CCR
101238(c)
Buildings and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, LPAs observed the inaccessible space behind the facility is not gated and accessible to children in care and poses potential safety risk to children in care.
POC Due Date: 09/09/2022
Plan of Correction
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Staff will ensure complete supervision and will install a gated and will show proof via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/06/2022 01:21 PM - It Cannot Be Edited


Created By: Mila Quinto On 09/06/2022 at 12:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review, staff has proof of immunization records on file.
POC Due Date: 09/06/2022
Plan of Correction
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Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above. The staff does not have proof of mandated reporter training on file which posesd a potential safety risk to children in care.
POC Due Date: 09/09/2022
Plan of Correction
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Staff will provide a copy of mandated reporter training certficate by due date and email to LPA Quinto at mila.quinto@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022


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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: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189
VISIT DATE: 09/06/2022
NARRATIVE
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Staff files were reviewed for staff present during the facility inspection on this date, 1 staff file were reviewed. Health screening and immunizations as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and within compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training, and to renew the training every two years. Staff does not have the mandated reporter training certificate available for review. 1 staff has a current pediatric CPR/First Aid certificate with expiration of August 2023, however it does not indicate EMSA approved.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 6 children’s files were reviewed. In the areas reviewed the children’s files were found to be in full compliance. Sign in/out procedure was reviewed for compliance. The person who signs the child in and out uses their full legal signature and records the time of the day.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. LPAs observed the inaccessible space behind the facility is not gated and accessible to children in care. LPAs also observed a trash bin without a lid on the outside of the front entrance used by children to dispose waste. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material made of rubber mats around the swings and slides appeared to be enough to absorbs falls. Drinking water in the outdoor activity space is provided by sports bottles with the child’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility. The facility grounds were safe, sanitary and in good repair.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
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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: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189
VISIT DATE: 09/06/2022
NARRATIVE
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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 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 Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

A copy of the 2016 link below “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative. English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
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
· 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
Based on LPAs observations, record reviews and interviews the following violations were observed and being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101170(d) Criminal Record Clearance; 101239(f)(1) Fixtures, Furniture, Equipment and Supplies; 101238(c) Buildings and Grounds; 101239.1(c) Napping Equipment and Health and Safety Code 1596.954 Carbon Monoxide are being cited on the attached LIC 809D.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
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: ST. JOACHIM SCHOOL
FACILITY NUMBER: 300614189
VISIT DATE: 09/06/2022
NARRATIVE
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An Inspection and exit interview was completed with facility representative. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. 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. If the facility receives a Type A violation, the licensee shall post and provide copies of the report to 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. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC809 (FAS) - (06/04)
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