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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370772
Report Date: 07/08/2024
Date Signed: 07/08/2024 12:18:46 PM

Document Has Been Signed on 07/08/2024 12:18 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:HAPPY MINDS KIDS ACADEMYFACILITY NUMBER:
304370772
ADMINISTRATOR/
DIRECTOR:
AFAZ, FASHANAFACILITY TYPE:
830
ADDRESS:24000 ALICIA PARKWAY # 35TELEPHONE:
(949) 455-1212
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 21DATE:
07/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Fashana Afaz, Licensee RepresentativeTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit as a result of a walk through inspection for a requested increase in capacity for the pre school license #304370771.
LPA observed total of 21 infants and 5 fully qualified teachers and one aide.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions

Upon walk through LPA went into pre school room 8 where 9 infants and three teachers were situated. Two infants were in the crib area. LPA observed Child #1(C1) asleep in crib face down. LPA requested lic 9227, Individual Sleep Plan and observed that Section C Infant's ability to roll was not completed.
LPA interviewed staff #1(S1) who stated that C1 had just entered program and did roll from the beginning of her enrollment. LPA P Rivas spoke with mom at 11:05am and was informed that C1 has never rolled over with them.
Based on LPA's observations, interview with staff and parent, review of records the following technical violation will be issued under Title 22 Division 12
101429(a)2(B)3-Responsibility for Providing Care and Supervision for Infants.

Exit interview conducted and report was reviewed with Director Fashana Afaz. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights discussed. Director was provided a copy of their 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.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
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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