Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300609833
Report Date: 06/24/2015 12:00:00 AM
Date Signed 06/24/2015 10:25:21 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:WARD, CLAUDIAFACILITY NUMBER:
300609833
ADMINISTRATOR:WARD, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 539-1044
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:12CENSUS: 9DATE:
06/24/2015
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Claudia Ward - LicenseeTIME COMPLETED:
10:30 AM
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LPA Jane Cong-Huyen met with the licensee, Claudia Ward, for a Plan of Correction (POC) visit. Licensee was cited for several Type A and B violations on 6/19/15. The licensee was cited for having 13 children in care with 4 infants when she can only have up to 3 infants when she is caring for more than 12 children in care. The licensee will be sending in proof of updated CPR and First Aid as well as TB test result for her staff by due date on 6/26/15 for TB test result and CPR and First Aid on 7/3/15. Licensee stated that she will sending those in by due dates.

During today's visit, LPA observed 9 children in care (2 infants, 4 preschoolers and 3 school-age) with the licensee and one assistant. A review of family member/staff records on this date indicates that all family members and/or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Based upon observation, the licensee is in ratio. The deficiency for ratio/capacity can be cleared today.

LPA reviewed files during today's visit. LPA observed LIC9224 signed by parents regarding Type A report.


No violation cited during today's visit.

Exit interview was conducted. 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. LPA informed the licensee of how to access regulations and forms from CCLD websites: www.ccld.ca.gov or Myccl.ca.gov and/ or http://ccld.ca.gov/PG411.htm. This report is to be on file and accessible for public review at the facility for at least 3 years.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jane Cong-HuyenTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2015
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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