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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370432
Report Date: 04/27/2026
Date Signed: 04/27/2026 11:27:40 AM

Document Has Been Signed on 04/27/2026 11:27 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:COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCHFACILITY NUMBER:
304370432
ADMINISTRATOR/
DIRECTOR:		FERGUSON, JENNIFERFACILITY TYPE:
850
ADDRESS:27005 BURBANK ROADTELEPHONE:
(949) 289-5580
CITY:FOOTHILL RANCHSTATE: CAZIP CODE:
92610
CAPACITY: 158TOTAL ENROLLED CHILDREN: 42CENSUS: 32DATE:
04/27/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Jennifer Ferguson (Director)TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 4/27/2026, Licensing Program Analyst (LPA) V. Trinh, and Licensing Program Analyst (LPA) M. Do conducted an unannounced case management inspection to follow up on an unusual incident that was reported by the facility to the Department on 3/26/2026. Upon arrival, LPAs met with Assistant Director Collins Jutta and was led on a tour. The overall census was 32 preschool children and five (5) staff members. Children were in the play yard and in classroom when the LPAs arrived. Around 10:15 am the Director Jennifer Ferguson arrived and assist the LPAs. Assistant Director Collins Jutta stated that the total enrollment is 42, 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 150 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 Monday- Friday, 8:00 am-5:00 pm.

A review of the Facility Personnel Report Summary on this date 4/27/2026 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 03/26/2026 stating that, at approximately 2:00 p.m., Staff 1 (S1) observed (witnessed) Staff 2 (S2) was sleeping while S2 was caring for five (5) toddlers for approximately seven (7) minutes. S1 notified the incident to the Assistant Director Jutta.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2026
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
VISIT DATE: 04/27/2026
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On 04/01/2026, LPA conducted an unannounced case management inspection. LPA obtained pertinent documents and conducted interviews with three (3) staff. Two (2) of the three (3) staff on duty were notified by staff 4 (S4) that S2 had been asleep for approximately seven (7) minutes while caring for five (5) toddlers. The LPA obtained documents and a photograph from S1’s phone showing that S2 was asleep at the time of the incident.

Based on record review and interviews, three (3) staff members stated that on 3/26/2026, in Classroom #9, there were five (5) toddlers in total and one (1) qualified staff member. All three (3) staff members reported that S2 fell asleep on the glider rocker chair in Classroom #9 for approximately 5–7 minutes while caring for the five (5) toddlers. The LPA obtained declarations from S3 and S4 stating that S2 was asleep.

Based on interviews, three (3) staff members stated that on 3/26/2026, in Classroom #9, S1 reported to S4 that all five (5) toddler children had not been eating lunch. S1 immediately checked all of the children’s lunch boxes and found that they were still full. At approximately 1:57 p.m., when S1 entered Classroom #9, S1 detected a strong odor from a soiled diaper that had not been changed.

Based on LPA’s record reviews and interviews, the following violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Care supervision CCR 101229(a)(1) and Infant personal care CCR 101428(b)(2), and is being cited on the attached LIC 809D.

LPA V. Trinh informed Director Jennifer Ferguson that this report, dated 03/18/2026, 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: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432
VISIT DATE: 04/27/2026
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Also, LPA V. Trinh informed the Director Jennifer Ferguson to provide a copy of this licensing report dated 4/27/2026 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 Acknowledgment 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 Director Jennifer Ferguson , and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted, and the report was reviewed with the Director Jennifer Ferguson .

Appeal Rights were explained. Director Jennifer Ferguson was provided a copy of the appeal rights, 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.

End of report.

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

DATE: 04/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/27/2026 11:27 AM - It Cannot Be Edited


Created By: Vivian Trinh On 04/27/2026 at 10:36 AM
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2026
Section Cited
CCR
101229(a)(1)

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101229 Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child shall be left without the supervision of a teacher at any time. Supervision shall include visual observation. This requirement is not met as evidenced by:
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The Director stated that S2 has already been terminated and held a staff meeting regarding the toddlers’ personal care will be conducted, with staff signatures documented and an email submitted to the LPA by the due date 05/01/2026
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Based on observation and interview, the licensee did not comply with the section cited above. On 03/26/2026, at approximately 2:00 p.m., Staff 2 (S2) was asleep while caring for five (5) toddlers for approximately seven (7) minutes, S2 did not provide adequate supervision while the children were sleeping. This poses an immediate risk to the children in care's health and safety.
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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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/27/2026 11:27 AM - It Cannot Be Edited


Created By: Vivian Trinh On 04/27/2026 at 10:38 AM
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: COUNTRY VILLAGE PRESCHOOL FOOTHILL RANCH
FACILITY NUMBER: 304370432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/27/2026
Section Cited
CCR
101428(b)(2)

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101428 Infant Care Personal Services (b) The infant shall be kept clean and dry at all times. (2) Each infant's/toddler’s clothing and diapers shall be changed as often as necessary to ensure that the infant/toddler is clean and dry at all times. This requirement is not met as evidenced by:
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The Director stated that S2 has already been terminated and held a staff meeting regarding the toddlers’ personal care will be conducted, with staff signatures documented and an email submitted to the LPA by the due date 05/01/2026.
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Based on observation and interview, the licensee did not comply with the section cited above. On 3/26/2026, S2 did not feed the five (5) toddler children lunch and did not change the toddlers’ diapers frequently enough to keep them clean and dry at all times, which posed a potential health, safety, or personal rights risk to the person 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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2026


LIC809 (FAS) - (06/04)
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