304371606-3-7-2023-06-CC-MMAK-CPPRQ2-20230307121249

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371606
Report Date: 03/07/2023
Date Signed: 03/07/2023 12:12:58 PM

Document Has Been Signed on 03/07/2023 12:12 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:	PACIFIC COAST CHURCH		FACILITY NUMBER:	304371606
ADMINISTRATOR:	EKSTRAND, KELSEY		FACILITY TYPE:	850
ADDRESS:	2651 CALLE FRONTERA		TELEPHONE:	(949) 940-2600
CITY:	SAN CLEMENTE	STATE: CA	ZIP CODE:	92673
CAPACITY:	30	CENSUS: 0	DATE:	03/07/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant/Director		TIME COMPLETED:	12:45 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 5 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced on site pre-licensing inspection at this location for the purpose of opening a new preschool program. The preschool is located on the ground of Pacific Coast Church. LPA met with the Applicant Kelsey Ekstrand. LPA was given a tour by the applicant of the entire facility. The applicant has requested to provide care and supervision for 30 preschool children ages 2.9 to 6 years old, Monday through Friday 8:00 AM to 3.00 PM. LPA observed the facility is following CDC and Dept of Public Health Guidelines. Due to COVID Pandemic parents shall be encouraged to follow the CDC and COVID requirements. Parents sign in and out electronically at the entrance of the building. The entrance is from the front side of the building entering from parking lot to a small lobby, and classrooms. Upon arrival each child has an health evaluation along with hand washing before they participate in the activities. Isolation area is in an office area, located at the entrance of the facility in the hallway and additional mats with beddings are provided for the sick child until the child is picked up. The bathroom for sick children is the staff bathroom which is close to this office area. One staff person stays with the sick child/children at all times. LPA discussed the posting requirements including, but limited to, the following: · Facility License in public area (101160) · Emergency Disaster Plan (LIC 610)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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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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: PACIFIC COAST CHURCH	FACILITY NUMBER: 304371606
	VISIT DATE: 03/07/2023

NARRATIVE

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· Earthquake Preparedness Check List (LIC 9148)
· Parents’ Rights Poster (PUB 393)
· Personal Rights (LIC 613A)
· Menus / Activity Schedule
· Notice of Site Visit (LIC 9213) and Type A deficiencies / Plan of Corrections of Type A deficiencies
· Granted Waivers (available for review)
· Child Car Seat Law (PUB 269)
Safe sleep posters / SIDS

The following was observed in the classrooms:

· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available inside through filtered water container and Dixie cups.
· Sign in/Sign out procedure was reviewed.
· Facility has in-built smoke detectors. There is fire extinguisher mounted that meets statutory requirements. Carbon Monoxide Detector will be provided,
· Cubbies available for storage of individual child’s personal belongings. More cubbies will be provided,
· Napping equipment: Children in this program will nap on mats, beddings will be provided by the parents and are washed weekly by parents.
· Facility has a full day and part day program and parents will provide AM/PM snacks and lunch to children.
Rooms are well lighted with proper ventilation.
Medications are stored in the locked area if any.
First Aid kit and Emergency kit is present.
No food preparation at this site. There is a refrigerator and freezer in the staff room.
There are additional snack available at site in case a child has forgotten his/her snack or needs more.

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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: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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: PACIFIC COAST CHURCH	FACILITY NUMBER: 304371606
	VISIT DATE: 03/07/2023

NARRATIVE

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LPA measured the classrooms and the measurements are as below:
Room 103 is 595.10 square feet
Room 104 is 439.07 square feet
Room 105 is 463 square feet
Total indoor capacity for the 3 classrooms are: 1497.25 square feet divided by 35= 42.78
(43 children)
Total sinks: 3 X 15= 45 children. There is one sink in each classroom.
Total toilets: 3 X 15=45 children. There is one toilet in each classroom.
Playground measurement: Outdoor activity space is 3752 square feet divided by 75 = 50.03
(50 children).
The following was observed for outdoor space:
· The Playground is fully enclosed by appropriate fencing at least 4 feet high. There is a gate on this playground opening to the court yard of the church leading to parking lot. The gate is a self latched gate that is equipped with a lock. Staff have key to lock and unlock the gate. The director advised to have additional lock on the top of the gate for extra caution. LPA discussed the supervision and staff stationing on the playground to watch out for the exit gate on the playground.
· Outdoor activity space is supplied with age and size appropriate equipment.
· There are climbing structure on the playground which will be added with adequate cushioning materials. (wood chips).
Shade will be provided.
Drinking water is provided by filter water container and Dixie cups.
Fire clearance received from Orange County Fire Authority approving the requested capacity of 30 preschool children. The total measurements of the 3 preschool classrooms, accommodate the requested capacity.

The director, Kelsey Ekstrand is current on the required Immunization/ Pediatric CPR/ First training, the Preventive Health training (Nutrition and Lead component) and Mandated Child abuse reporting training certificate.

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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: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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: PACIFIC COAST CHURCH	FACILITY NUMBER: 304371606
	VISIT DATE: 03/07/2023

NARRATIVE

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Criminal Record Statement : The Applicants were 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Safe Sleep LPA discussed the safe sleep regulations with applicant and director and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at
https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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

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

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 platform.

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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: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC809 (FAS) - (06/04)

Page: 4 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: PACIFIC COAST CHURCH	FACILITY NUMBER: 304371606
	VISIT DATE: 03/07/2023

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To receive important license 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A license for 30 preschool children age 2.9 to 6 years old, Monday to Friday 8:00 am to 3:00 PM in rooms 103, 104, and 105 will be issued after receiving the following corrections, final review, and management approval. The applicant will be notified if any additional documents are needed before issuing a license. On today's inspection, the director submitted/corrected additional documents to LPA which was requested. Please send the following within 30 days of today's date.

1- Securing the tall shelves, bookshelves to the wall in all the classrooms.
2- Installing baby gates in front of all the doors in the classrooms for extra cushion. Some doors lead to parking lot. Total of 9 doors.
3- Installing extra lock/latch on the gate on the playground leading to the court yard and parking lot.
4- Installing Carbon Monoxide Detector.
5- Posting requirements
6- Providing additional cushioning materials under and around falling zones of the play structure on the playground.
7- Providing shaded area on the playground.
8- Providing napping equipment.
9- Providing additional cubbies for all the 3 classrooms.
10- Final picture of the classrooms with additional toys/games/book/children's activities to show the classroom settings.
11- Director's packet for new director. (Director's packet items were given to Kelsy Ekstrand.
Exit interview conducted and report was reviewed with the Applicant, Kelsey Ekstrand.
End of reports

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC809 (FAS) - (06/04)

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