304270494-8-11-2023-06-CC-MMAK-CULS5V-20230811133457

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270494
Report Date: 08/11/2023
Date Signed: 08/11/2023 01:35:08 PM

Document Has Been Signed on 08/11/2023 01:35 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	CAPISTRANO USD/LAS FLORES ELEMENTARY SCHOOL		FACILITY NUMBER:	304270494
ADMINISTRATOR:	PINO, MARIA		FACILITY TYPE:	850
ADDRESS:	25862 ANTONIO PARKWAY		TELEPHONE:	(949) 589-6935
CITY:	RANCHO STA MARGARITA	STATE: CA	ZIP CODE:	92688
CAPACITY:	24	CENSUS: 0	DATE:	08/11/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee		TIME COMPLETED:	12:00 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	Page 1 of 3 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility for the purpose of the facility moving from room D104 to room D107. The facility has been licensed for 24 children in room D104. The facility has not requested changing capacity. LPA met with Lauren Pattullo the director of Early Childhood, General Education and Special Education Programs of Capistrano Unified School District who gave LPA a tour of the facility. The facility is located on the ground of Las Flores Elementary School. The Site Supervisor of this site is Maria Pino. There were no children present due to Summer Break. The facility is running Title 5 program and operating from 8.00 am to 3.00 PM, Monday to Friday serving children ages 3-5 years old offering one full day session in Room D107 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 staff are employees of Capistrano Unified School District. The full day hours is from 7:50 am to 2:50 pm. The facility provides morning breakfast and afternoon lunch to children. Children nap in this room. They nap on mats. Parents provide beddings and are sent home to be washed on a weekly basis. The children are dropped off and are singed in and out at the entrance manually. The facility has not met all the posting requirements. All areas identified on the Facility Sketch were inspected. If children become ill during the day, they will rest in the isolation area located, in the nurse’s office, next to the school office, away from the other children, and use the adult restroom. Continued on page 2

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAPISTRANO USD/LAS FLORES ELEMENTARY SCHOOL	FACILITY NUMBER: 304270494
	VISIT DATE: 08/11/2023

NARRATIVE

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Following was observed in room D107:
Age appropriate furniture and activities including Educational, arts and crafts items.
Room is well ventilated with proper lighting and shade.
There is a working Smoke detector, Carbon Monoxide detectors and Fire Extinguisher.
Outdoor Activity Space: Playground is completely enclosed. Outdoor activity area is supplied with age and size appropriate equipment with adequate of cushioning materials under the climbing structure and slide. Shade is provided by building shade. The play yard is shared with TK and children of Special Education Program. There is a waiver to share the playground on file.

Fire clearance approval has not been received approving the requested capacity of 24 children in room D107 yet.

The measurement of room D107 is as below:
Room D107 is 732.286 square feet
Total indoor measurement for room D107 is 732.286 square feet divided by 35 square feet =-20.99
(21 children).
Toilets: 2 X 15= 30 children
Sinks: 3 X 15 = 45 children.
There is on toilet and one sink in the Girls bathroom and one toilet, one sink in the Boys bathroom. There is one sink in room D107. The facility has a waiver to share restrooms on the Elementary Campus.
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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.

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CAPISTRANO USD/LAS FLORES ELEMENTARY SCHOOL	FACILITY NUMBER: 304270494
	VISIT DATE: 08/11/2023

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LPA reviewed with applicant the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care- licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the licensee, Lauren Pattullo.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Based on today’s measurements, the sinks and toilets availability, the request of the facility for moving to room D107 with a capacity of 21 will be final reviewed and discussed with management in the Regional Office and after receiving the following corrections. The facility will be notified if any additional information is required. Fire clearance approval is required before children can use this room.

1- A check for 25.00 payable to DSS for the reduced capacity to 21 children since the measurement of the room was enough for 21 children.
2- Securing the children's items such as refrigerator, stove, sink, dress up cabinet and wooden pantry in dramatic area.
3- Signs for the bathroom to state 'Preschool" in the shared bathroom.
4- Licensing posting requirements.
5- Complete list of site supervisor packet for this facility. Items on the list was given to the licensee.
End of report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC809 (FAS) - (06/04)

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