<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270891
Report Date: 01/09/2024
Date Signed: 01/09/2024 03:26:17 PM

Document Has Been Signed on 01/09/2024 03:26 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:CANO SITE IIFACILITY NUMBER:
304270891
ADMINISTRATOR:MANNING, ALTAFACILITY TYPE:
850
ADDRESS:1211-1219 SOUTH MAINTELEPHONE:
(714) 835-4100
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 15DATE:
01/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Ruby PorterTIME COMPLETED:
03:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/9/2024, Licensing Program Analyst (LPA) A. Silva conducted a Case Management – Deficiencies due to deficiencies observed. An on-site Facility Personnel Report Summary review indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Census was 15 preschool children at the time of visit. The facility was operating within ratios and capacity.

The licensee did not report to the Department an unusual incident that took place in October 2023. According to CCR 101212(d)(1)(C) Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. … (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

Based on records review and interviews, the facility is being cited in accordance with the California Code of Regulations, Title 22, Division 12, for the following section: 101212(d)(1)(C) Reporting Requirements.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with director Ruby Porter.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/09/2024 03:26 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 01/09/2024 at 03:17 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: CANO SITE II
FACILITY NUMBER: 304270891

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
101212(d)(1)(C)

1
2
3
4
5
6
7
101212(d)(1)(C) Reporting Requirements (d) Upon the occurrence ... of any of the events specified in (d)(1) below, a report shall be made to the Department … (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
1
2
3
4
5
6
7
The director will review the regulation and send a declaration stating she understands the reporting requirements regulations. The director will provide a declaration via email by the due date.
8
9
10
11
12
13
14
The licensee did not comply with the above regulation as evidenced by: Based on records review and interviews, the director did not report an unusual incident that happened on October 2023 as required by the Department.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2