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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371682
Report Date: 01/23/2025
Date Signed: 01/23/2025 11:22:31 AM

Document Has Been Signed on 01/23/2025 11:22 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HERITAGE HILL KINDERCAREFACILITY NUMBER:
304371682
ADMINISTRATOR/
DIRECTOR:		CAMARENA, ESMERALDAFACILITY TYPE:
860
ADDRESS:21791 LAKE FOREST DRIVETELEPHONE:
(949) 344-6951
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 33DATE:
01/23/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:14 AM
MET WITH:Stard, Stephanie (Director)TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 1/23/2025 at 9:15 AM Licensing Program Analyst (LPA) Vivian Trinh conducted an unannounced case management incident inspection in response to a self reported Unusual Incident dated 1/15/2025. LPA met with Director Stephanie Strand. LPA observed 11 infant children with 4 staff members, 11 toddler children with 3 staff members, and 11 preschool children with 2 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 1/15/ 2025, a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 1/14/2025, that Staff #1 (S1) fed a bottle of formula milk to Child #1 (C1) that belonged to Child #2 (C2). Staff #2 (S2) stated and confirmed that the bottle of formula milk was belonged to C2.

During staff interviews on 1/23/ 2025, (S2) and Staff #3 (S3) admitted that S1 fed a bottle of formula milk belonging to Child #2 (C2) to Child #1 (C1). S3 stated that she had retrained few of the infant staff's classroom about feeding infant food services. S3 emphasized that whenever any staff member takes a bottle to feed a child, they need to confirm with a co-worker and initial the staff name on the feeding log.

During the inspection on 1/23/2025, (LPA) observed that each child's full name was listed on each bottle. Additionally, the LPA observed that teachers were initiating bottle logs when feeding children in care.

Based on the information gathered from the self reported unusual incident report, observations, and interviews with two (2) staff members, it was determined that (S1) fed a bottle of formula milk to Child #1 (C1) that belonged to Child #2 (C2). The facility was not in compliance and violations of the California Code of Regulations, Title 22, Section 101427(j) Infant Care Food Service. See LIC 9099-D. Continued Page 2.

SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: HERITAGE HILL KINDERCARE
FACILITY NUMBER: 304371682
VISIT DATE: 01/23/2025
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Exit interview conducted and report was reviewed with the Director Stephanie Strand. Notice of site visit was given and must remain posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights and deficiencies were discussed. The Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

End of the Report.

SUPERVISORS NAME: Nguyen K Tran
LICENSING EVALUATOR NAME: Vivian Trinh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/23/2025 11:22 AM - It Cannot Be Edited


Created By: Vivian Trinh On 01/23/2025 at 10:34 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: HERITAGE HILL KINDERCARE
FACILITY NUMBER: 304371682

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2025
Section Cited
CCR
101427(j)

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101427 Infant Care Food Service (j) Bottles, dishes, and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.
This requirement is not met as evidenced by:
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The Director will conduct the staff meeting regarding infant food services, and send a copy with staff signatures before the due date.
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Based on self-reported unusual incident report,and interviews with two (2) staff members, it was determined that C1 was fed a bottle of formula milk to Child #1 (C1) that belonged to Child #2 (C2), which risk to the health, safety, or personal rights 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:Nguyen K Tran
LICENSING EVALUATOR NAME:Vivian Trinh
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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