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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370681
Report Date: 10/02/2023
Date Signed: 10/02/2023 04:26:28 PM

Document Has Been Signed on 10/02/2023 04:26 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:IREMNANTFACILITY NUMBER:
304370681
ADMINISTRATOR:SONG, LYDIA MI SOOKFACILITY TYPE:
850
ADDRESS:1521 D W. ORANGETHORPE AVE.TELEPHONE:
(714) 882-0860
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 88TOTAL ENROLLED CHILDREN: 88CENSUS: 44DATE:
10/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Grace Kang, Director TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Patricia Duron conducted an unannounced case management investigation for the incident which the facility self reported to licensing office on 09/20/23. The unusual incident report stated an unusual incident occurred at the facility on 9/19/23, the Director stated Child #1 (C1) and Staff #1 (S1) were in classroom, a parent (P1) heard yelling and heard a staff saying "stop crying". Director stated that P1 stated they witnessed S1 shaking C1's body and head.

Upon arrival LPA, was met by Director Grace Kang, LPA explained the reason for today's visit. Director provided a tour of the facility. LPA observed 8 preschool staff and 44 preschool children in care during today’s visit.

A review of facility Personnel Report Summary 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. During today's inspection, LPA Duron interviewed 1 staff, reviewed documentation and review staff files.

Due to insufficient information available at this time, case management needs further investigations.

An exit interview conducted with Director. The Director was provided a copy of 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.

Notice of Site Visit was provided and posted. Notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2023
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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