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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371170
Report Date: 09/09/2021
Date Signed: 09/09/2021 11:37:54 AM

Document Has Been Signed on 09/09/2021 11:37 AM - 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:VILLAGE PRESCHOOL ACADEMYFACILITY NUMBER:
304371170
ADMINISTRATOR:GARCIA, THERESAFACILITY TYPE:
850
ADDRESS:18052 IMPERIAL HWYTELEPHONE:
(714) 993-3444
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 99TOTAL ENROLLED CHILDREN: 0CENSUS: 54DATE:
09/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Theresa Garcia, DirectorTIME COMPLETED:
12:00 PM
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On 09/09/2021, Licensing Program Analyst (LPA) Mila Quinto conducted a visit at the facility. The purpose of this visit was to conduct a Case Management Evaluation of the facility. LPA Quinto met with the director, Theresa Garcia. Census was taken in individual classrooms. The overall census observed was 9 preschool staffs and 54 preschool children. 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.

On 08/27/21, the facility self-reported that a child was crying when staff was changing the diaper and child states staff hurt them while changing diaper.

LPA interviewed 4 staff members including the director regarding the incident. LPA also interviewed the child’s parent via telephone. Based on the interview with Staff #3 (S3), child has been saying no when staff would change the diaper after bowel movement. Staff #4 (S4) have also witnessed the child saying no and witnessed child saying a staff hurt them. Staff #1 (S1) and Staff #2 (S2) were not present during the incident, however conducted the interview with S1, S2 and parent. Based on LPA's interview with the parent, child does not like to have their diaper changed after bowel movement at home. Parent did not express any safety concern with the facility as this also occurs at home and family members have struggled to change the child's diaper after bowel movement. Based on the interviews conducted and the information obtained, there is not a preponderance of evidence to support the child's disclosure.

An exit interview was completed with director. The report was reviewed and discussed. Appeal Rights and were discussed. The director was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. Notice of Site Visit was posted. The notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2021
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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