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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270647
Report Date: 12/03/2025
Date Signed: 12/03/2025 02:44:52 PM

Document Has Been Signed on 12/03/2025 02:44 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:FAMILY CAMPUS PRESCHOOLFACILITY NUMBER:
304270647
ADMINISTRATOR/
DIRECTOR:		VICTORIA HERNANDEZFACILITY TYPE:
850
ADDRESS:10540 CHAPMAN AVENUETELEPHONE:
(714) 741-0970
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 43DATE:
12/03/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Facility Representatives, Sarah Pham and Victoria HernandezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 12/3/2025, Licensing Program Analyst (LPA) K. Trinh conducted an unannounced case management inspection to follow up on an unusual incident that was reported by the facility to the Department. Upon arrival, LPA met with Facility Representatives, Sarah Pham and Victoria Hernandez. LPA disclosed the purpose of the inspection and was led on a tour of the facility. There were 43 preschool children, and 7 preschool staff members present.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The Department received an incident report on 11/13/2025 stating that on 10/14/2025, some staff mentioned that Staff 1 (S1) was aggressive toward Child 1 (C1) when they were redirecting C1 in the classroom. Human Resources (HR) spoke with all staff and reviewed the camera footage from 10/14/2025. HR then shared the video footage to Program Director, Sarah Pham, Site Supervisor, Victoria Hernandez, and the Vice President.

On 11/20/2025, LPA conducted an unannounced case management inspection. LPA obtained pertinent documents and conducted interviews with five staff and two children. Two out of five staff interviewed stated that they observed S1 holding down C1. One staff member shared that they were present during the incident and Staff 4 (S4) observed S1 screaming at C1 more than once and holding down C1’s arms and legs.

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NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647
VISIT DATE: 12/03/2025
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LPA obtained and reviewed video footage of the incident. Camera view shows an angle from the upper corner of the classroom near the front door. There is no audio in the video footage. Based on the timestamps shown on the video footage, LPA observed that on 10/14/2025, at 9:47 AM, C1 threw toys at Child 3 (C3). C1 then grabbed and yanked on C3’s hoodie, and C3 responded by hitting C1’s left arm. C1 attempted to hit C3 as they were walking away. S1 intervened, holding both of C1’s hands and guiding them to the library corner of the classroom. C1 sat on the floor and S1 helped C1 up and move to the library chair, continuing to hold C1’s wrists while speaking with them. At 9:49 AM, S4 entered the camera view, grabbing an activity box, and placing it on the table. S1 continued holding C1’s hands. C1 began squirming, and S1 held C1’s arms down. S1 was observed speaking into the walkie-talkie. At 9:50 AM, Staff 5 (S5) entered the classroom. S5 spoke with S1, and S5 walked toward the library area. S1 then walked away from the library area of the classroom and was seen using a phone.

Following the incident, Facility Representatives, Sarah Pham and Victoria Hernandez held a staff meeting on 11/26/2025, to provide support for staff and discuss children’s personal rights and strategies to address children’s behaviors.

Based on LPA’s record reviews and interviews the following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101223(a)(3), is being cited on the attached LIC 809D.

LPA K. Trinh informed Facility Representatives, Sarah Pham and Victoria Hernandez that this report dated 12/3/2025 documents one (1) Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

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NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647
VISIT DATE: 12/03/2025
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Also, LPA K. Trinh informed the Facility Representatives, Sarah Pham and Victoria Hernandez to provide a copy of this licensing report dated 12/3/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given to Facility Representatives, Sarah Pham and Victoria Hernandez and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Facility Representatives, Sarah Pham and Victoria Hernandez.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

End of report.
NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Kathy Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/03/2025 02:44 PM - It Cannot Be Edited


Created By: Kathy Trinh On 12/03/2025 at 02:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/04/2025
Section Cited
CCR
101223(a)(3)

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101223(a)(3) Personal Rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature...
This requirement was not met as evidenced by:
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Facility representatives will hold a staff meeting to train staff on supervision concerns and children's personal rights. Facility representatives will provide LPA with the staff sign in sheet by the due date.
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Based on record review and interviews, the licensee did not comply with the section cited above in that, S1 was aggressive towards C1, which poses an immediate health, safety or personal rights risk to persons in care.
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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.
Tina Nguyen
NAME OF LICENSING PROGRAM MANAGER:
Kathy Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2025


LIC809 (FAS) - (06/04)
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