Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370807
Report Date: 09/20/2016
Date Signed: 09/20/2016 01:18:06 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:RENASCENCE SCHOOL INTERNATIONAL PRESCHOOLFACILITY NUMBER:
304370807
ADMINISTRATOR:BURKET, MARIELAFACILITY TYPE:
850
ADDRESS:2987 MESA VERDE EASTTELEPHONE:
(714) 336-8015
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:48CENSUS: 33DATE:
09/20/2016
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:LicenseeTIME COMPLETED:
01:45 PM
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The purpose of this visit was to conduct a case management visit of the facility for the purpose of increasing capacity by adding one more room to the existing capacity. Licensing Program Analyst (LPA) Malek met with licensee, Carrie Mizera in the office at the time of the visit. The director, Mariela Burket was teaching in the classroom. Census was taken. There were a total of 33 preschool children with 5 staff observed in three classrooms. The facility is currently licensed for 48 preschool children in rooms L4, L5, and L5(ll). The facility has requested to provide care and supervision to 60 children by adding room L3.
New adding room (L3 ) was measured. The room is approximately 420 square feet. There is one portable sink in this new classroom.
Based on the measurement of today and previous measurement the total indoor space is approximately 2122 square feet that accommodates 60 children in rooms L3, L4 L5, and L5(ll).
There are a total of 4 toilets and 5 sinks in the building for the use of the children for this facility.
Based on the measurement of the existing playground dated 9/11/2012 the total outdoor space area is approximately 7476 square feet divided by 75 = 99 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 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 director was provided a copy of their appeal right (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the updates.
This report is to be on file and accessible for public review at the facility for at least 3 years. Exit interview was conducted. In the areas evaluated, no deficiencies were observed and cited today per CA Code of Regulations, Title 22, and Division 12.
An updated license is issued today for 60 preschool children in rooms L3, L4, L5, and L5(ll).
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2016
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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