<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370788
Report Date: 04/25/2023
Date Signed: 04/25/2023 04:48:14 PM

Document Has Been Signed on 04/25/2023 04:48 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:HANDS TOGETHERFACILITY NUMBER:
304370788
ADMINISTRATOR:JESSICA GUTIERREZFACILITY TYPE:
850
ADDRESS:201 E CIVIC CENTER DRIVETELEPHONE:
(714) 479-0294
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 53DATE:
04/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Karina Chavez - DirectorTIME COMPLETED:
04:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Carmen Odom conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 4/19/2023. LPA met with Director Karina Chavez. LPA observed 53 preschool age children getting ready for nap with 7 staff members. 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 4/19/2023 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported at 2:32pm during nap time while parent was picking up child #1 (C1) upon removing blanket parent observed C1’s bottoms were above the knees. During today’s visit, LPA obtained an updated copy of the children’s roster, personnel report, daily schedule and interviewed director, and 4 staff. Due to insufficient information available at this time, the reported incident needs further investigation.

Exit interview was conducted. The Notice of Site Visit was posted. Director Karina Chavez 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.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1