Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370734
Report Date: 05/21/2018
Date Signed 05/21/2018 01:25:21 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2018 and conducted by Evaluator Jung Mi Han
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20180515132021
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: 48DATE:
05/21/2018
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Hannah Hemenway - DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to fix broken water fountain.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPAs Han and Taylor toured the facility and a census taken. The overall census observed was 5 preschool staffs, 48 preschool children and 1 director. A review of staff criminal clearance records on this date indicates that all facility staffs or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

At 9:45 AM, LPA Han and LPA Taylor observed a drinking water fountain which located in larger preschool outdoor play area is broken. Preschool children goes to sand play area when they need drinking water. LPA Taylor interviewed 5 staff. Director stated the fountain has been broken over 2 months and the facility is looking for a part that is back order. Director also stated staff are bringing out a water pitcher with paper cups for children when children play in outside play area. This practice started about 2 weeks ago. The director stated some children brought their own water bottle before. Staff stated the children are not allow to share the cup and also supervising the children to prevent contamination of cup or bottle.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 06-CC-20180515132021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/21/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2018
Section Cited
CCR
101238(a)
1
2
3
4
5
6
7
Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times. This requirement is not met based on observation.
1
2
3
4
5
6
7
Director stated they are looking for other resource to fix the problem as soon as possible. Director will send the proof of working water fountain.
8
9
10
11
12
13
14
During today's inspection at 9:50AM, LPAs observed a drinking water fountain is broken in preschool outdoor play area. This failure to protect children poses an potential health and safety risk to the children in care.
8
9
10
11
12
13
14
CCR
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
8
9
10
11
12
13
14
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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2018
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2018 and conducted by Evaluator Jung Mi Han
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20180515132021

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: 48DATE:
05/21/2018
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Hannah Hemenway - DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to provide readily available drinking water outside.
Staff failed to prevent contamination of water bottle.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Han and LPA Taylor toured the facility and a census taken. The overall census observed was 5 preschool staffs, 48 preschool children, and 1 director. A review of staff criminal clearance records on this date indicates that all facility staffs or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

At 10:15 AM, LPA Han and LPA Taylor observed preschool children play in outdoor play area. No children had a personal water bottle. LPAs conducted interviews with 5 staff. All staff stated they are watching children to make sure they do not share the drinking cup. The staff and children stated they go to other drinking water fountain in the sand play yard to get water from the fountain..

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20180515132021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/21/2018
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Section 101238(a) – Buildings and Grounds is being cited on the attached LIC 9099D.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2018
LIC9099 (FAS) - (06/04)
Page: 4 of 4