Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370736
Report Date: 09/02/2015 12:00:00 AM
Date Signed 09/02/2015 06:03:45 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:
304370736
ADMINISTRATOR:WALSWICK, ERICFACILITY TYPE:
840
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92867
CAPACITY:14CENSUS: 16DATE:
09/02/2015
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Eric WalswickTIME COMPLETED:
06:15 PM
NARRATIVE
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The purpose of this visit was to conduct a Case Management Evaluation of the facility. LPA Hanson toured the facility inside and outside. Census was taken in individual classrooms. The overall census observed was 2 school-age staff and 16 school-age children. 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.

Upon entering the outdoor activity area, LPA Hanson observed 2 staff with 16 school-age children. The facility is only licensed for 14 school-age children. LPA Hanson discussed this with the director. LPA Hanson was informed that the private kindergarten children are mixed with the after school-age. The director stated that their private kindergarten ends at 2:30 PM, but the parents don't always pick up on time.

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.

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 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' MUST BE POSTED ON OR ADJACENT TO THE DOOR. FAILURE TO POST TYPE A REPORTS FOR 30 DAYS WILL RESULT IN A CIVIL PENALTY OF $100.00.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Judy HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2015
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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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: 304370736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2015
Section Cited
101161(a)
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Limitations on Capacity and Ambulatory Status. The licensee shall not exceed the conditions, limitations and capacity specified in the license. The facility is licensed for 14 school-age children, however, there were 16 children in care.
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The director will submit to Licensing a written plan for maintaining appropriate capacity 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: 09/02/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2015
LIC809 (FAS) - (06/04)
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