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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370044
Report Date: 07/17/2025
Date Signed: 07/17/2025 02:34:02 PM

Document Has Been Signed on 07/17/2025 02:34 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:CANYON VISTA ELEMENTRY SCHOOLFACILITY NUMBER:
304370044
ADMINISTRATOR/
DIRECTOR:		LORI SILVAFACILITY TYPE:
840
ADDRESS:27800 OAKVIEW DRIVETELEPHONE:
(949) 831-1264
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92656
CAPACITY: 130TOTAL ENROLLED CHILDREN: 130CENSUS: 52DATE:
07/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Assistant Director, Irem Sepici and Director, Lori SilvaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 07/17/2025 at 1:30pm, Licensing Program Analyst (LPA) Sarah Garcia and Licensing Program Manager (LPM) Nguyen Tran conducted a case management- incident visit in response to a self-reported unusual incident report (LIC 624) received on 06/12/25 regarding children’s personal rights being violated. This is a continuation of the investigation initiated on 6/24/25. LPA met with assistant director, Irem Sepici and director, Lori Silva. A walk through of the facility was conducted, and census was taken. Total census was 52 school age children and 4 staff. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 06/12/2025, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 06/10/25, Staff 3 (S3) is no longer working at the facility due to Child 1 (C1) alleging that S3 slapped them. The facility Human Resources (HR) department conducted an internal investigation and S3 admitted to tapping the child on the shoulder as a result of asking C1 multiple times to refrain from using profanity and making inappropriate comments. Facility HR spoke with authorized representatives of C1 on 6/16/2025 and 6/17/2025.

During the course of the investigation, LPA Garcia interviewed 3 staff, authorized representative/parent and Child 1 (C1). LPA obtained C1's LIC 700, S3's personnel record (LIC 501), LIC 624, facility plan of correction, facility discipline guide, training agenda, and staff sign in sheet from training conducted on 6/18/2025.

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NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2025
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: CANYON VISTA ELEMENTRY SCHOOL
FACILITY NUMBER: 304370044
VISIT DATE: 07/17/2025
NARRATIVE
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During staff interviews, S1 and S2 stated that they were informed of the incident, notified Human resources (HR) Department and it was reported to licensing in a timely manner. Per S1 and S2, Staff 3(S3) no longer works at the facility. Staff 3 (S3) confirmed S3 did make physical contact to C1 during the incident. During child’s interview C1 did not make disclosures regarding the allegations.

When LPA asked staff about children with challenging behavior, Staff 1 (S1) and Staff 2 (S2) stated the facility policy is talk with the child and allow them time to collect themselves. When LPA asked staff if they have observed or experienced any child discipline by staff that was inappropriate, Staff 1 (S1) and Staff 2 (S2) stated they have not observed that.
LPA reviewed facility's corrective plan of action. The plan practices the positive behavior support model which works to prevent challenging behavior. Teachers help children develop self-control and social skills by treating them with respect, fairness and consistency. Teachers model and coach appropriate behavior to children. Discipline such as hitting, pushing, pulling, and physical force is prohibited.

LPA requested a copy of police report from Orange County Sheriff's Department on 07/10/2025 and 07/16/ 2025. LPA was unable to receive police report.

Based on LPAs record review and interviews there was enough evidence to determine violation of personal rights. California Code of Regulations, Title 22, Division 12 Section 101223(a)(3) Personal Rights is being cited on the attached LIC 809D.

LPA Sarah Garcia informed facility that this report dated 07/17/2025 documents (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. Also, LPA Sarah Garcia informed facility to provide a copy of this licensing report dated 07/17/2025 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.



Exit interview conducted and report was reviewed with assistant director, Irem Sepici and director, Lori Silva. A notice of site visit was given and must remain posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/17/2025 02:34 PM - It Cannot Be Edited


Created By: Sarah Garcia On 07/17/2025 at 01:51 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: CANYON VISTA ELEMENTRY SCHOOL
FACILITY NUMBER: 304370044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2025
Section Cited
CCR
101223(a)(3)

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Personal Rights (a) (3)
To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion... physical functioning.
This requirement is not met evidenced by:
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Staff 3 (S3) no longer works at the facility. Facility submitted a behavior management plan, training agenda, and staff sign in sheet from training conducted on 6/18/2025.
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Based on LPAs record review and interviews Staff 3 (S3) made physical contact with Child 1 (C1) during an incident which poses an immediate personal rights risk to children 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.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Sarah Garcia
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2025


LIC809 (FAS) - (06/04)
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