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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270647
Report Date: 03/18/2026
Date Signed: 03/18/2026 03:02:42 PM

Document Has Been Signed on 03/18/2026 03:02 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: 60CENSUS: 52DATE:
03/18/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Victoria Hernandez(Site Supervisor)TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 03/18/26, Licensing Program Analyst (LPA) V. Trinh and Licensing Program Analyst (LPA) Madeline Do conducted an unannounced case management inspection to follow up on an unusual incident reported by the facility to the Department on 2/12/2026. Upon arrival, LPA met with Program Director, Sarah Pham, and Victoria Hernandez (Site Supervisor). LPA was informed of the purpose of the inspection and was led on a tour of the facility. There were 13 toddlers and two (2) staff members, 39 preschool children and five (5) staff present at the time of inspection. Victoria Hernandez (Site Supervisor) stated that the total enrollment is 60, and that children are on a staggered schedule and arrive at different times throughout the day and are aware that they cannot exceed the capacity ratio of 112 children at any one time. During the inspection, it was determined that the facility is operating within its licensed capacity and in compliance with staff-to-child ratios. Hours of operation are 7:00 AM-6:00 PM, Monday through Friday.

A review of the Facility Personnel Report Summary conducted on this date 03/18/26 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA met with the Program Director, Sarah Pham, and Victoria Hernandez (Site Supervisor). According to the incident report, Child 1 (C1) was playing inside the playhouse and jumped out of the window (approximately 2 feet above the ground) and landed on his left elbow and sustained an injury to his left elbow while playing in the playhouse. Staff #4 (S4) approached and provided assistance to C1 by applying an ice pack and administering first aid. C1's parent was notified. Victoria Hernandez (Site Supervisor) stated that C1 returned to school on 2/18/26.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2026
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: 03/18/2026
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During the course of the investigation, LPA interviewed four (4) staff members and three (3) preschool children, obtained a copy of the children's roster (LIC 9040), and C1’s record and incident report, LIC 500 Personnel Report, Parents Handbook, Doctor note restriction for C1, Meeting Agenda for Team meeting with Teachers signature, playground map with where the teachers are standing on the day and time of the incident, and Video footage 02/11/2026.

LPA conducted an inspection on 2/19/2026 and conducted (4) staff interviews and attempted to interview 3 children, and 1 child qualified to be interviewed. 4 staff members interviewed stated they did not witness C1 being hurt; however, they heard C1 was crying, and S4 assisted C1 with first aid and an icepack. The LPA also interviewed C1, who stated that he jumped out of the window on his own, with no one pushing him from behind. S4 stated they notified the administrator.

During inspection on 02/19/2026, LPA inspected the playground to ensure the facility has sufficient cushioning (synthetic grass with padding under the climbing structures) to meet safety requirements. LPA reviewed video footage dated 2/11/2026 and observed C1 had jumped out of the playhouse, was on the floor holding their elbow and crying, and S4 was near the child and slowly approached to assist C1.

The program director, Sarah Pham, and the site supervisor, Victoria Hernandez, met on 2/16/26 to review playground safety and supervision procedures.

Victoria Hernandez stated that she will continue to remind the children not to jump from any structures, especially the playhouse, and not to run on the playground. She also said she will instruct staff to allow children to play in small sections and to rotate them through the play yard at set intervals to maintain closer supervision and prevent similar incidents in the future.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The program director, Sarah Pham, and the site supervisor, Victoria Hernandez, were provided a copy of their appeal rights and their signature on this form, receipt of these rights. The facility representative/director was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days.

The End of the Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026
LIC809 (FAS) - (06/04)
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