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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371682
Report Date: 10/28/2025
Date Signed: 10/28/2025 03:02:29 PM

Document Has Been Signed on 10/28/2025 03:02 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: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: 61DATE:
10/28/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Director, Stephanie StrandTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 10/28/2025 at approximately 9:45AM, Licensing Program Analyst (LPA) Jung conducted an unannounced case management inspection to follow up on an unusual incident that was reported by the facility to the Department. Upon arrival, LPA met with Director, Stephanie Strand. LPA disclosed the purpose of the inspection and was led on a tour of the facility. There were 37 infant children, 10 infant staff, 24 preschool children, and 4 preschool staff members present.

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.

An Unusual Incident Report (UIR) was submitted to the Department on 10/23/2025 reporting that Child 1 (C1) was fed the wrong bottle by Staff 1 (S1) on the morning of 10/23/2025. During the visit, LPA conducted interviews with staff and reviewed documents pertinent to the investigation. According to staff interviewed, S1 had entered the classroom to give Staff 3 (S3) their morning break. Before S3 left for their break, they had put two infant bottles in the bottle warmer. Without following the facility’s Feeding Log policy, S1 grabbed one of the bottles from the bottle warmer and began feeding C1. Staff 2 (S2), who was also in the room, noticed that S1 was feeding C1 from the wrong bottle. S2 communicated the mistake to S1, but C1 had already ingested one ounce from the wrong bottle. Staff involved communicated the incident to the Director, and Director spoke with families of both children involved.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Soo Jin Jung
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 10/28/2025 03:02 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 10/28/2025 at 01:22 PM
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: 10/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
Section Cited
CCR
101427(g)

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101427(g) ... Bottles and nipples used by one infant shall not be shared with or used by another infant... This requirement was not met as evidenced by:
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Director stated that they will implement additional measures for infant feeding procedures. Director stated that they will provide training to staff and submit signatures of all staff for training to LPA via email by due date.
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Based on interviews, the licensee did not comply with the section cited above in that, S1 fed C1 the wrong bottle during feeding, which poses a potential health, safety or personal rights risk to persons 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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Soo Jin Jung
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2025


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: 10/28/2025
NARRATIVE
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Director stated that they will retrain staff on Feeding Log policy and implement additional measures to the feeding procedure to ensure that staff do not feed the wrong bottle to infants going forward.

Director provided LPA with copies of C1 and C2's daily report detailing their feeding times from the day of the incident, as well as facility roster, Child Supervision Record (CSR), and Bottle Feeding Log from the day of the incident.

Facility staff reported the incident to the Department in a timely manner. Based on the information obtained and interviews conducted, one Type B citation for Infant Care Food Service is being cited; see LIC 809D for deficiency. Facility was cited for the same deficiency on 1/23/2025 and 5/28/2025. As this is a repeat citation, civil penalty was issued; see LIC 421FC for civil penalty.

Report was reviewed with Director, Stephanie Strand, and Notice of Site Visit was given which must remain posted for 30 days.

End of report.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Soo Jin Jung
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025
LIC809 (FAS) - (06/04)
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