Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270251
Report Date: 08/14/2018
Date Signed: 08/14/2018 12:13:31 PM

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:45CENSUS: 0DATE:
08/14/2018
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Laura Bullock TIME COMPLETED:
12:45 PM
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Case management inspection made today by Licensing Program Analysts (LPAs)Connolly and Taylor. Inspection is made due to facility submitting an application for an increase in capacity. Facility is currently licensed for 45 children. Facility has requested an increase to 60. Fire clearance was issued 6/26/18.

Upon today's arrival LPAs met with director Laura Bullock who accompanied on a tour of the facility. No children were present as school resumes 8/201/8. Rooms currently being used are rooms 607 and the Kindergarten Readiness room. Room requested to be licensed is room 602. Room 602 was measured today.
Days and hours of operation are Monday through Friday 7:00 AM to 6:00 PM.
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with sink, toilet, and mat/cot was inspected. Isolation area is located in the school's office. Availability of drinking water was reviewed. LPAs observed 1 toilet and 1 sink in classroom 602 which is an addition to the already existing five sinks and three toilets. The age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation.

The play yard is exclusive to this preschool program. The following is the schedule to playground use: Room 607 is on the playground 0830 to 0930, Room 602 is on the playground 10:30 -11:00 AM and 12:00 - 12:30 PM. The Kindergarten Readiness Room schedule for the playground is 0930 - 10:00 AM and 11:30 AM - 12:00 PM. Playground water fountain is operational and in good repair.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine ConnollyTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2018
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MISSION BASILICA SCHOOL
FACILITY NUMBER: 304270251
VISIT DATE: 08/14/2018
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Room measurements are as follows:
Room 602: 24.83 x 19.33 = 480 divided by 35 = 14

Outside measurements:
Large playground area: 48 x 64 = 3,072
Playground table area : 38 x 7 = 266
Total yard is 3338 square feet divided by 75 = 45 children

Total sinks = 6 x 15 = 75
Total toilets = 4 x 15 = 60

Director was informed that prior to licensure a waiver request is required for playground use as playground measures for 45 children total at any one time. Waiver request submitted this date.

During today's inspection the director provided an updated Personnel Report (LIC 500) and an updated Designation of Facility Responsibility (LIC 308).

Licensing report was reviewed with the director. The director was informed that capacity is limited to 59 children due to indoor activity space. The new room by measurement can only accommodate 14 children bringing total capacity to 59.


Additionally the LPAs informed the director that a final review of the file will be done before the license is issued. The director will be notified if any corrections or additions still need to be completed.

Notice of Site Visit was posted.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine ConnollyTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2018
LIC809 (FAS) - (06/04)
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