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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370289
Report Date: 06/26/2024
Date Signed: 06/26/2024 11:20:52 AM

Document Has Been Signed on 06/26/2024 11:20 AM - 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:WESTMINSTER SCHOOL DISTRICT-SEQUOIA PRESCHOOLFACILITY NUMBER:
304370289
ADMINISTRATOR/
DIRECTOR:		BECERRA KARINAFACILITY TYPE:
850
ADDRESS:5900 IROQUOIS ROADTELEPHONE:
(714) 894-7271
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
06/26/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Darcy Spicer, Early Education CoordinatorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) P Rivas and Office Technician (OT) Ebony Vasquez conducted an office meeting with Ms. Darcy Spicer Early Education Coordinator for the purpose of reviewing lic 200a and facility sketch in order to send out a fire clearance.
LPA discussed lic 200a and faciliyt sketch. The applicant only wants to adding room C-4 and keeping room C-3.
LPA discussed notice of incomplete application .
Advised to submit the following;
1. Provide board resolution designating applicant.
2. Provide updates for personnel policies and parent hand book or if there are none, provide a statement to his effect.
3. Lic 500 Personnel report provide one that has sufficient staff for the capacity requested. If positions are not filled indicate To Be Hired.
4. Lic 610 provide two relocation sites, answer all questions.

If you have any questions contact Patricia Rivas Licensing Program Analyst at patricia.rivas@dss.ca.gov. Provide corrections by July 26, 2024.

Exit Interview conducted.

Applicant advised that a fire clearance will be sent out as soon as correct facility sketch is completed.
.

An exit interview was conducted.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2024
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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