304370134-3-4-2025-06-CC-MMAK-DEFU2U-20250304141229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370134
Report Date: 03/04/2025
Date Signed: 03/04/2025 02:12:51 PM

Document Has Been Signed on 03/04/2025 02:12 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:	HIDDEN HILLS ELEMENTARY		FACILITY NUMBER:	304370134
ADMINISTRATOR/ DIRECTOR:	FLOTHO, LISA		FACILITY TYPE:	850
ADDRESS:	25142 HIDDEN HILLS ROAD		TELEPHONE:	(949) 495-0050
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 8	DATE:	03/04/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:25 PM
MET WITH:	Staff in charge		TIME VISIT/ INSPECTION COMPLETED:	02:20 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 4 Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite inspection for the purpose of an Annual inspection. The site supervisor, Lisa Flotho was not present. LPA met with staff in charge Mabel Chieng, and Mirozalva Velasco. There was a total of 8 preschool children in Room 6, and 7 (combined to a large room). The applicant has also requested to decrease their capacity from 24 preschool children to 16 preschool children ages 3 to 5 years old in this large combined room of 6 and 7. The fire clearance has received in our office and approved for 16 children. The indoor activity space measurement for the current requested capacity is as follows: Room 6 and 7 combined (one room only) is 39 X 30.07= 1172.73 divided by 35 square feet 33.50 (33 children). The State Preschool shares the playground with other program on different scheduling. (waiver to share is on file). The facility also has an approved waiver for main streaming with special education children. There are 4 toilets and three sinks in the girl's bathroom and there are 2 toilets, 2 urinals, and 3 sinks in the boy's bathroom that this facility shares with elementary children. (waiver to share is on file) The State Preschool runs Title 5 Program. Facility hours are 8:00 a.m.- 3:00 p.m., Monday through Friday. The facility runs morning and afternoon sessions. Morning session is from 8 am to 11 am and afternoon session is from 12 noon to 3:00 pm. Parents sign their children in and out manually. A review of the Facility Personnel Report Summary on this date indicates 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 and they are exempt of fingerprinting). The classroom was inspected. During the inspection of the indoor activity space, items which could pose a danger to children (cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Facility provides breakfast and lunch for morning and afternoon sessions. Menu was posted. Floors, equipment, and furniture were clean and were Continue to page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HIDDEN HILLS ELEMENTARY	FACILITY NUMBER: 304370134
	VISIT DATE: 03/04/2025

NARRATIVE

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observed to be in good repair and free of sharp edges. Drinking water is available to children indoors by water dispenser from outside drinking water company with using disposable cups. Children do not nap in this program because the program is part time. The facility has conducted an emergency fire drill within the past six months, last drill was in 2/19/2025. The facility has a working carbon monoxide detector. Facility met all posting requirement.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The cushioning material around the climbing equipment and slide appeared to be enough to absorb falls. (commercial foam material). Drinking water in the outdoor activity space is provided by filtered water from outside drinking water company. The outdoor equipment and toys were in good repair and free of sharp edges. Shade is provided. There are no bodies of water present at the facility.

Staff files were reviewed for staff present during the facility inspection on this date, 2 staff files were reviewed. Health screening and immunization 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 childcare center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for staff were reviewed and were in 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. They were in compliance. At least one staff member present shall posses current EMSA approved Pediatric CPR/First Aid certifications, which was not in compliance.

Children's records were reviewed, and there was a separate, complete and current record for each child. A random sample of 5 children's files were reviewed for documentation of the child’s name, address, and telephone number of the child’s authorized representative and of relatives or others that can assume responsibility for the child if the authorized representative cannot be reached when necessary (LIC 700) and a medical assessment. In the areas reviewed the children’s files were found to be in full compliance.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs)
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: HIDDEN HILLS ELEMENTARY	FACILITY NUMBER: 304370134
	VISIT DATE: 03/04/2025

NARRATIVE

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constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). However, the facility is using drinking filtered water from water dispenser from a private water company. There are no sinks in the room for drinking or food preparation. Children wash their hands in the sinks located on the restrooms located on the elementary school ground. The facility has submitted written attestation and is approved and is exempt from water lead testing. This facility is not required to test any water outlets per Health and Safety Code 1597.16 at this time.

LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. No children with medication at this time. For IMS information see PIN 22-02-CCP. 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 are available at:https://www.ada.gov/resources/child-carecenters

The facility representative, Mirozalva Velasco was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides 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.

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

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: HIDDEN HILLS ELEMENTARY	FACILITY NUMBER: 304370134
	VISIT DATE: 03/04/2025

NARRATIVE

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https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communications.

The facility representative, Mabel Chieng 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.

To improve the quality and value of the new inspection process, a survey may be sent to the

email address provided. Please complete the survey and share your inspection experience. If
you have any questions regarding the process or CARE tools, please send email inquiries to
inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its
tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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

In the areas that were evaluated, the following deficiency of Section 101216(f) for lacking of current CPR and 1st aid for staff was observed of the California Code of Regulations, Title 22, Division 12 at this inspection date. Please see 809D.

Exit interview conducted and report was reviewed with The facility representative, Mirozalva Velasco.

End of report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/04/2025 02:12 PM - It Cannot Be Edited

Created By: Mahnaz Malek On 03/04/2025 at 01:45 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: HIDDEN HILLS ELEMENTARY	FACILITY NUMBER: 304370134
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, and record review, the licensee did not comply with the section cited above in two counts out of 2 counts of staffs' files that Staff # 1 did not have current CPR and 1st aid. Staff # 2 did not have current card either which poses a potential health, and safety risk to persons in care.
	POC Due Date: 03/11/2025
	Plan of Correction
1 2 3 4	The facility representative agreed to send a plan of correction of fixing the above issue. They will send a statement acknowledging one staff person with current CPR and 1st aid shall be present at all times during preschool operation,

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Thuy Ho

LICENSING EVALUATOR NAME:

Mahnaz Malek

LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025

LIC809 (FAS) - (06/04)

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