Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270251
Report Date: 08/04/2017
Date Signed: 08/04/2017 10:13:59 AM

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:MISSION BASILICA SCHOOLFACILITY NUMBER:
304270251
ADMINISTRATOR:BULLOCK, LAURAFACILITY TYPE:
850
ADDRESS:31641 EL CAMINO REALTELEPHONE:
(949) 234-1385
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:25CENSUS: 0DATE:
08/04/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:DirectorTIME COMPLETED:
10:30 AM
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The purpose of this visit was to conduct a case management inspection of the facility. The facility has requested to increase their capacity by adding a new room. The preschool is located on the Mission Basilica Church. There is also an elementary private school is located on this campus. Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek met with director, Laura Bullock and principal, Alycia Beresford in the office. LPA toured the facility with the school representatives. The preschool was out for summer. The facility is currently licensed for 25 preschool children in one classroom and additional nap room. The existing classroom was inspected. The measurement of this existing classroom is 882 square feet. The new classroom was measured today and was approximately 700 square feet. There is one sink in each classroom. The nap room will not be on the license any more. There are a total of 5 sinks and 3 toilets available for preschool children. Children need to be escorted to the bathroom with a staff person and supervised when they use the bathroom.
The facility has requested to provide care and supervision for 45 preschool children ages 2 through 5 years old. Monday through Friday from 7:00 am to 6:00 pm
The total measurement is 1582 square feet that accommodates 45 preschool children.
A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The facility does not have any children with IMS yet. 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 playground measurement is approximately 3600 square feet that accommodates 45 preschool children.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2017
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 2


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: MISSION BASILICA SCHOOL
FACILITY NUMBER: 304270251
VISIT DATE: 08/04/2017
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The Notice of Site Visit was posted. Facility representative 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. The licensee was provided a copy of their appeal right (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates. Exit interview was conducted.
The facility representative was informed that the Criminal Record Statement (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC 9182).
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The following website link for infant's safe sleep information in English and Spanish was given. www.cdph.ca.gov/programs/sids/documents/sidschildcaresafesleep.pdf
In Spanish
www.cdph.ca.gov/programs/sids/documents/childcareprovsleepspan2011.pdf

A copy of child care provider's guide to safe sleep pamphlet was given to the staff member.
A copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org was given to the facility representative.
In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12. No deficiency was cited.

An updated license will be issued for a capacity of 45 preschool childrn in two rooms.




This report ends here.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2