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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370846
Report Date: 04/19/2023
Date Signed: 04/19/2023 05:05:27 PM

Document Has Been Signed on 04/19/2023 05:05 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:NOBIS PRESCHOOLFACILITY NUMBER:
304370846
ADMINISTRATOR:NEITZKE, ASHLEYFACILITY TYPE:
850
ADDRESS:26153 VICTORIA BLVD.TELEPHONE:
(949) 661-6258
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 30DATE:
04/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Assistant Director, Erica BenavidesTIME COMPLETED:
05:15 PM
NARRATIVE
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On 04/19/23, Licensing Program Analysts (LPAs) Dianna Valdez Santana and Giselle Lucero conducted an unannounced case management visit to deliver deficiencies noted. LPAs were assisted by Assistant Director Erica Benavides. During today's inspection there were a total of 30 preschool children and 4 staff members.


A review of the Facility Personnel Report Summary conducted on 04/13/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPAs observed the preschool playground had a broken metal play dome/structure was broken at the top, posing a potential risk to children in care. The dome was partially surrounded with the children’s bikes leading children directly in the direction of the broken play structure.

During the inspection, observation, staff interviews it was disclosed that the Director is only present at the facility 1-3 times a week. Staff stated she is usually at another campus.

The facility will be cited for two Type B violations, California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101215.1(d) Child Care Center Directors Qualifications and Duties and Section 101239(n) Fixtures, Furniture, Equipment and Supplies. See LIC 809D.

Exit interview was conducted with facility representative. Notice of Site Visit was posted during the visit. Assistant Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Facility Representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Deficiencies were discussed. First level appeals should be sent to the regional manager to the address listed above.

End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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Document Has Been Signed on 04/19/2023 05:05 PM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 04/19/2023 at 04:49 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: NOBIS PRESCHOOL
FACILITY NUMBER: 304370846

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
04/28/2023
Section Cited
CCR
101215.1(d)

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101215.1(d)- Child Care Center Director Qualifications and Duties: The child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation.
This requirement was not met as evidenced by:
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The facility will turn in a director packet for assistatnt director, to become the official Director for the faciilty. Assistant Director will talk to the Director about being more present until she becomes the official director. Packet will be submitted to LPA by due date via email: dianna.valdezsantana@dss.ca.gov
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Through observation and staff interviews it was disclosed that the Director is usually at another campus and only at the facility 1-3 a week.
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Type B
04/28/2023
Section Cited
CCR101239(n)

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101239(n)- Fixtures, Furniture, Equipment and Supplies: Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.
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Facility will repair/complete the play dome. Facility will send LPA pictures via email by due at dianna.valdezsantana@dss.ca.gov

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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:Thuy Ho
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023


LIC809 (FAS) - (06/04)
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