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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270647
Report Date: 12/11/2023
Date Signed: 12/11/2023 01:22:49 PM

Document Has Been Signed on 12/11/2023 01:22 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:FAMILY CAMPUS PRESCHOOLFACILITY NUMBER:
304270647
ADMINISTRATOR:VICTORIA HERNANDEZFACILITY TYPE:
850
ADDRESS:10540 CHAPMAN AVENUETELEPHONE:
(714) 741-0970
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 36DATE:
12/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Victoria HernandezTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) A. Bootorabi and V. Trinh conducted an unannounced visit for a Self Reporter Unusual Incident Report (UIR) investigation on 12/11/2023.

Upon arrival, the LPA met with the Director,Victoria H. , and informed the purpose of the investigation inspection.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Census upon arrival: Monkeys 11:2 - Bears & Frogs 25:4 Teachers Outside

The department received a self reported UIR via telephone on 12/06/2023. The facility was reporting a UIR regarding personal rights.
LPA conducted 7 staff interviews, 3 file reviews, 2 children interviews and collected children roster, staff rosters, and sign in/out sheet for Monday 12/06/2023 .

Due to insufficient information available at this time, the above UIR needs further investigation.

An exit interview was conducted with Director, Victoria H . Notice of Site Visit was posted during the visit. The director was informed that the notice of the site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First-level appeals should be sent to the regional manager to the address listed above.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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