300603868-4-25-2023-06-CC-GLUO-CR8RZ3-20230425132716

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300603868
Report Date: 04/25/2023
Date Signed: 04/25/2023 01:27:19 PM

Document Has Been Signed on 04/25/2023 01:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCH		FACILITY NUMBER:	300603868
ADMINISTRATOR:	MARIETTA GILLIARD		FACILITY TYPE:	850
ADDRESS:	321 E. CHAPMAN AVE.		TELEPHONE:	(714) 992-7070
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 60	CENSUS: 40	DATE:	04/25/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director Marietta Gillard		TIME COMPLETED:	01:50 PM

NARRATIVE

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Licensing Program Analysts (LPA) Giselle Lucero and Patricia Duron conducted a case management investigation for the incident that the facility self-reported to licensing office on 04/21/2023. According to the incident report, the incident occurred on 4/20/2023 at approximately 4:57 PM, C1 walked out of the lower play yard and walked passed S1 that was assisting a parent (A1) during sign out. C1 was observed sitting on a ramp which is located in front of room#2 by A1.

Upon arrival LPA, was met by Director, Marietta Gillard. Director provided a tour of the facility. LPA observed 40 preschool children and 6 preschool staff in care during today’s visit. Director was explained the reason for today's visit upon arrival.

A review of the Facility Personnel Report Summary conducted on 04/25/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the course of the investigation, LPAs interviewed 3 children and 3 staff, obtained a copy of the children's roster (LIC 9040), facility roster, sign in/out copy of the day of the incident, IEP (Individual educational plan) for C1 and reviewed records.

Due to insufficient information available at this time, further interviews is needed, the case management for the incident needs further investigation. Exit interview conducted with Director Gillard and notice of site visit must be posted at entrance of facility. Notice of site visit is to remain posted for no less than 30 days. Failure to post will result in civil penalties of $100. Appeal Rights was explained

End of Report.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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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