Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370734
Report Date: 02/05/2018
Date Signed 02/05/2018 09:49:52 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:FUN 4 KIDS PRESCHOOLFACILITY NUMBER:
304370734
ADMINISTRATOR:HEMENWAY, HANNAHFACILITY TYPE:
850
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY:76CENSUS: 24DATE:
02/05/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Hannah Hemenway-DirectorTIME COMPLETED:
10:15 AM
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A case management inspection in regard to a self reported incident that happened on 1/25/18. LPA toured the facility and observed 24 preschool children with 3 staff and the director. 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.


During today's inspection LPA Taylor interviewed 4 children, interviewed 1 staff and reviewed files. No other children were interviewed regarding incident due to the age of the child who are too young to verbally communicate.

There is insufficient information available at this time to make a determination if incident took place at the facility or after child left the facility. The incident needs further investigation.

After a tour of the facility, the following no deficiency was observed or cited in accordance with Title 22, Division 12.

Exit interview was conducted. The Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 703-2820
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2018
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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