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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370691
Report Date: 12/09/2025
Date Signed: 12/09/2025 01:49:06 PM

Document Has Been Signed on 12/09/2025 01:49 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:CITY OF LA HABRAFACILITY NUMBER:
304370691
ADMINISTRATOR/
DIRECTOR:		LIZETTE QUIROZFACILITY TYPE:
850
ADDRESS:215 N. EUCLID STREETTELEPHONE:
(562) 905-9630
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 29DATE:
12/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:58 PM
MET WITH:Program Specialist, Minerva Alvarez TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Cynthia Sun conducted an unannounced case management incident inspection in response to a self-reported Unusual Incident dated 11/13/2025. During the inspection, LPA met with Program Specialist Minerva Alvarez and observed 29 preschool children and 6 staff members. Children were napping while staff supervised children.

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 11/13/2025, the facility submitted a self-reported Unusual Incident Report (UIR) to the Licensing Office regarding an incident that occurred on 11/12/2025. The report stated that Child #1 (C1), Child #2 (C2), and Child #3 (C3) were left unsupervised outside the classroom in facilities playground.



During the visit, LPA interviewed the staff #1 (S1) who stated that on 11/12/25, C1, C2, and C3 were gathered with the rest of the class, ready to go into the classroom after outdoor play. Staff typically line up with children in the front and back of the line. On this day, there was commotion between other children in the line and staff that are typically on the back of the line moved to the children having commotion. All the children and staff walked together into the classroom and went directly to the classroom sink to wash hands. Staff #1(S1) counted the children in the classroom and realized that three children were missing. By that time, staff #3 (S3) came to classroom with the C1, C2, and C3 and informed S1 that C1, C2, and C3 were playing in playground. S3 stated C1, C2, and C3 were unharmed and unaffected. S3 stated C1, C2, and C3 were in the playground unsupervised for 4-5 minutes.
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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2025
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: CITY OF LA HABRA
FACILITY NUMBER: 304370691
VISIT DATE: 12/09/2025
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LPA interviewed C1, C2, and C3’s parents who stated facility informed them what had happened with C1, C2, and C3. Parents stated they were not upset with the facility or staff, but they were upset with their own children. Parents also stated they spoke to their children at home about following class rules and listening to teachers.
LPA reviewed the facility’s playground, and playground is safe for children. The playground has two gates that access the street. Both gates have loud alarms that sound off when gates open. The gates latches are about 5 ft. in height making gate latches inaccessible for children to open. Facility has a wall over 5 ft. surrounding playground to prevent children access to the street. Facility also provided a Plan of Correction where facility has implemented more strategies for counting and supervising children in care. Staff #5 stated that “they have a scheduled meeting/ training with director. In the training, staff will review headcounts, teacher positioning, and expectations moving forward”.

Based on the interview conducted and the self-reported incident, it has been determined there was lack of supervision, as staff were unaware to C1, C2, and C3 being left unattended outside the classroom for approximately 4-5 minutes. However, the children were safe in the facility playground and C1, C2, and C3 were unable to leave facility.

The facility is in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101229(a)(1); Responsibility for providing care and supervision. One Type B violation cited. Please refer to the attached LIC 809D form.

LPA Sun informed Program Specialist Minerva Alvarez that this report dated 12/09/2025, document(s) one Type B citation which shall be posted for 30 consecutive days.


Exit interview was conducted. The Notice of Site Visit was posted. Program Specialist Minerva Alvarez was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.

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END OF REPORT
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/09/2025 01:49 PM - It Cannot Be Edited


Created By: Cynthia Sun On 12/09/2025 at 01:27 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: CITY OF LA HABRA
FACILITY NUMBER: 304370691

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
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Program Specialist, Minerva Alvarez stated facility would be conducting an all staff training on 11/19/25.Training provided staff guidance for children supervision, counting children, licensing requirements, children head counts, teacher positioning and expectations.
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This requirement is met as evidence by: Based on LPA’s interviews, 3 out of 3 staff stating they witnessed C1, C2, and C3 were left on playground unsupervised for about 4-5 minutes which poses a potential health risk to the 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.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Sun
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2025


LIC809 (FAS) - (06/04)
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