304371093-5-12-2021-06-CC-LBAS-C2XSQS-20210512140512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371093
Report Date: 04/19/2021
Date Signed: 05/12/2021 02:06:08 PM

Document Has Been Signed on 05/12/2021 02:06 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:	FULLERTON CHILDREN'S ACADEMY		FACILITY NUMBER:	304371093
ADMINISTRATOR:	MARGARITA CALERO		FACILITY TYPE:	850
ADDRESS:	3516 W. COMMONWEALTH AVENUE		TELEPHONE:	(714) 680-0567
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92833
CAPACITY: 62	TOTAL ENROLLED CHILDREN: 0	CENSUS: 32	DATE:	04/19/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Director Margarita Calero		TIME COMPLETED:	03:30 PM

NARRATIVE

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The purpose of this visit was to obtain signature and delivery of an amended Case Management Report and correction of Civil Penalty Assessment (LIC421FC)dated 04/19/21. Amended report to correct the civil penalty issued for $1000 in error on 05/15/19. The correct civil penalty amount is $250.

Licensing Program Analyst (LPA) Barajas met with Director Margarita Calero. LPA toured the facility inside and outside. Census was taken. There was a total of 32 preschool age children with 4 staff.

A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

An exit interview was conducted with Director Margarita Calero. Report was read to Director. A copy of the report along with Appeal Rights will be emailed to Director with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, Director will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 9099 will also be mailed if those options are not available.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Leonor Barajas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021

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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