Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370734
Report Date: 07/08/2015 12:00:00 AM
Date Signed 07/08/2015 12:55:09 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:FUN 4 KIDS PRESCHOOLFACILITY NUMBER:
304370734
ADMINISTRATOR:PARRA, VIELKAFACILITY TYPE:
850
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92867
CAPACITY:76CENSUS: 42DATE:
07/08/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Eric WalswickTIME COMPLETED:
01:00 PM
NARRATIVE
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The purpose of this visit was to conduct an Annual/Random Evaluation of the facility using KIT 1. LPA Hanson and LPA Taylor toured the facility inside and outside. Census was taken in individual classrooms. The overall census observed was 5 preschool staff and 42 preschool children. Food storage, sign in/out, 1st aid/CPR, cleaning supplies storage, napping equipment, carbon monoxide detector, and drinking water were inspected. Facility met all posting requirement. The facility representative was informed that the California Child Passenger Safety Law needs to be posted by the entrance of the facility. Staff files and children's records were reviewed. There was required information missing from the staff files. LPA Hanson was informed that the new director has been in place since December 2014. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA was informed by facility representative that this facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA Hanson discussed with the director the requirements for updating the facility Plan of Operation to include the type of IMS they offer. LPA Hanson informed the facility representative that the Universal Precautions must be posted in the facility if they perform IMS that includes, but not limited to, blood glucose monitoring and Gastric Tube feeding.

In the areas that were evaluated, the facility was not in compliance and violation(s) of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Judy HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
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 4


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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2015
Section Cited
101212(a)(b)
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Reporting Requirements. Each licensee shall furnish Licensing reports as required by the Department including, but not limited to, the following: Whenever a change in child care center director, and it shall be reported to the Department within 10 days of a change.
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A director packet will be submitted to the Licensing office by the due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Judy HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
LIC809 (FAS) - (06/04)
Page: 4 of 4


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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734
VISIT DATE: 07/08/2015
NARRATIVE
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An exit interview was completed. Appeal Rights and deficiencies were discussed. A copy of the Appeal Rights was given to the facility representative. All appeals must be in writing and received by the Licensing office within 10 days. If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and to the parents/guardians of children newly enrolled at the facility during the next 12 months. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. The facility representative was also informed that she can get Licensing updates at www.ccld.ca.gov

THE 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 $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR. FAILURE TO POST Type A reports for 30 days will result in a civil penalty of $100.00.

Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
- Fire Drill Log
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Judy HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2015
Section Cited
101229.1(a)(1)
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Sign In and Sign Out. The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
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The director will remind all parents to use full legal signature when signing in/out the child. A copy of the reminder will be submitted to the Licensing office by the due date.
Type B
07/29/2015
Section Cited
101238.2(e)
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Outdoor Activity Space. All playground equipment shall be cushioned with material that will absorb a fall. There is a need for additional cushioning material unter the swings and the climbing structure.
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Verification of that additional cushioning material has been added shall be submitted to the Licensing office by the due date.
Type B
07/29/2015
Section Cited
101238.2(d)(2)
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Outdoor Activity Space. Outdoor activity space shall be hazard free. There were holes and uneven gound in the play yard.
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Verification of that the holes are have been filled and the ground was even shall be submitted to the Licensing office by the due date.
Type B
07/15/2015
Section Cited
101217(e)
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Personnel Records. In all cases, personnel records shall document the hours actually worked. There was no time sheet for the director.
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The director will submit to the Licensing office by the due date verification that a current time sheet is being kept.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Judy HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2015
LIC809 (FAS) - (06/04)
Page: 3 of 4