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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370879
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:45:10 PM

Document Has Been Signed on 09/27/2023 04:45 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:KIDDIE ACADEMY OF TUSTINFACILITY NUMBER:
304370879
ADMINISTRATOR:ESTRADA, ELAINAFACILITY TYPE:
850
ADDRESS:14501 NEWPORT AVENUETELEPHONE:
(714) 508-0005
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 47DATE:
09/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Assistant Director, Sylvia Gonzalez TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Dianna Valdez Santana conducted a case management investigation to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 09/22/2023. It was reported by Elaina Alcaraz, Director via fax. According to the report, the unusual incident occurred on 09/21/2023. A parent reported observing a bruise on child #1’s (C1) in a inappropriate area.

Upon arrival LPA was met by Assistant Director, Sylvia Gonzalez, Director Elaina Alcarez arrived later to the facility, LPA and assistant director toured the facility inside and outside and a census was taken as follows: 6 preschool staff including assistant director with 47 preschool 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.

During the investigation and interviews, the incident did not occur at the facility and the proper authorities have been informed of the incident. Facility reported the incident within 24 hours and is found to be in compliance with Title 22 Division 12 reporting requirements.

During today's inspection LPA Valdez Santana reviewed files and interviewed 4 staff members. LPA did not interview children due to the nature of the incident.

During today's staff's interview, there was no disclosure from the staff members.

Based on LPA observations, interviews which were conducted, and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies are being cited during today's inspection.

End of Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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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