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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371436
Report Date: 05/22/2024
Date Signed: 05/22/2024 01:22:38 PM

Document Has Been Signed on 05/22/2024 01:22 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:PEACOCKS EARLY LEARNING CENTREFACILITY NUMBER:
304371436
ADMINISTRATOR/
DIRECTOR:		KHANNIA OKFACILITY TYPE:
850
ADDRESS:19901 YORBA LINDA BLVD.TELEPHONE:
(714) 970-2311
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 52DATE:
05/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Director Khannia OkTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 5/22/2024, at 11:35am Licensing Program Analyst (LPA) Anna Chan conducted an unannounced complaint visit. Upon arrival, the LPA met with Director Khannia Ok. LPA informed director of the purpose of visit. LPA was led on walk through of the facility by the staff and a census was taken. LPA observed 6 staff and 52 preschool children.

During the course of a complaint investigation on 5/9/24, LPA observed and discovered the napping equipment in room #1 (18 mats), #3 (21 mats), and #4 (13 mats) showed exposed foam.

Based on record reviewed the following deficiency was discussed and cited. The facility was not in compliance with the California Code of Regulations, Title 22, Division 12, Section 101239.1(b)(5) Napping Equipment. Please refer to 809D for details of deficiency.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Director Khannia Ok 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. Appeal rights and deficiency provided and explained. The Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

End of Report

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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Document Has Been Signed on 05/22/2024 01:22 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 05/22/2024 at 11:39 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: PEACOCKS EARLY LEARNING CENTRE
FACILITY NUMBER: 304371436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/24/2024
Section Cited
CCR
101239.1(b)(5)

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Napping Equipment
(b) Floor mats used for napping shall be:
(5) Maintained in a safe condition with no exposed foam.
This requirement is not met as evidenced by:
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Director stated the facility ordered new sleeping mats. Director stated she will send a copy of the invoice/order form and photos of all new mats per classroom to LPA by due date of 6/24/24.
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Based on LPA observation napping equipment in room #1 (18 mats), #3 (21 mats), and #4 (13 mats) showed exposed foam.

This poses as a potential risk to health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Martha Malane
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024


LIC809 (FAS) - (06/04)
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