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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371682
Report Date: 04/21/2026
Date Signed: 04/21/2026 06:01:12 PM

Document Has Been Signed on 04/21/2026 06:01 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:		BROWN, BARBARAFACILITY TYPE:
860
ADDRESS:21791 LAKE FOREST DRIVETELEPHONE:
(949) 344-6951
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 108TOTAL ENROLLED CHILDREN: 77CENSUS: 72DATE:
04/21/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Facility Representative, Barbara BrownTIME VISIT/
INSPECTION COMPLETED:
01:41 PM
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In response to a self-reported Unusual Incident Report (UIR) dated 04/17/2026, Licensing Program Analyst (LPA), Deschampe conducted an unannounced case management-incident inspection on this date, 04/21/2026, with arrival at the facility at 9:30 AM. Present during today’s inspection was the Facility Representative/Director (FR), Barbara Brown. Total enrollment is 77, with 72 children and 18 staff at the time census was taken, due to varied schedules. A review of staff criminal records on this date 04/21/2026 indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 04/17/2026, the UIR was filed with the Orange County Regional Office (OCRO) to self-report an incident from 04/16/2026. FR stated on the report, there were 15 children and 2 staff at the time of the incident. Staff 1 (S1) was reading to a group of children in the carpet area of the classroom when S1 saw Child 1 (C1) had climbed on the arm of a child-size play chair and fell back and hit her head on the window frame. Staff 2 (S2) was changing diapers at the time of the incident. S1 got up and assisted C1 and noticed a laceration on the back of C1's head. S1 went and supervised the other children once finished with diaper changing. S2 immediately called Staff 3 (S3) who observed the laceration. S3 contacted the FR. Parent 1 (P1) took C1 to Kaiser Urgent Care Mission Viejo. C1 received 2 staples on the back of the head.

LPA made observations, reviewed facility records, attempted to interview children, conducted interviews with 4 staff and P1. No children interviews were conducted due to not qualifying for the Ten Step Investigative Interview questions. During staff interviews, 2 out of 2 staff (present in the classroom at the time of incident) stated they had asked C1 to sit down prior to the incident. Immediately following the incident, facility staff moved the 2 child-sized chairs from in front of the window to against the wall, and a foam protector has been purchased to be installed on the window frame. No deficiencies cited during this visit.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2026
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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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: 04/21/2026
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Exit interview conducted and report was reviewed with the facility representative/director, Barbara Brown. Appeal Rights were discussed with facility representative. The facility representative was provided a copy of the 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. A notice of site visit was given and must remain posted for 30 consecutive days. The “Notice of Site Visit” must be posted on, or immediately adjacent to, the interior side of the main door to the facility. Failure to post will result in Civil Penalties of $100.00. End of Report.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Susan Deschampe
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026
LIC809 (FAS) - (06/04)
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