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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371730
Report Date: 04/07/2025
Date Signed: 04/07/2025 01:01:04 PM

Document Has Been Signed on 04/07/2025 01:01 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:HILLSBOROUGH PRIVATE SCHOOLFACILITY NUMBER:
304371730
ADMINISTRATOR/
DIRECTOR:		ULIBARRI, JAYLENAFACILITY TYPE:
860
ADDRESS:4757 VALLEY VIEWTELEPHONE:
(714) 572-5696
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 97TOTAL ENROLLED CHILDREN: 97CENSUS: 20DATE:
04/07/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Director Jaylena UlibarriTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 04/07/2025 at 9:15am, Licensing Program Analyst (LPA), Romy Castanon conducted an unannounced prelicesing inspection to decrease the facility’s preschool capacity and add an infant component in Yellow and Red Room (previously preschool rooms). This is a single license conversion. The existing license number (304270907) will be consolidated with the new assigned license number (304371730). Upon arrival, LPA met with Director Jaylena Ulibarri. Applicant Lacy Bonner joined later during the facility tour. Applicant is requesting to be licensed for 24 infants ages 6wks-24mos in the Yellow & Red Room and 73 preschool children ages 2-6 yrs in Blue & Green Room for a total capacity of 97.

Review of Criminal record clearances were verified through Guardian. All staff were fingerprinted and cleared. There were 20 children and 3 staff present during today’s visit. The hours of operation are Monday-Friday 7:00am to 6:00pm.

During today's visit LPA measured Yellow and Red Room for infant component use for a total of 1,481.25 square feet which is sufficient to meet the capacity requested for the infant program. LPA observed all indoor activity space to be complete with age-appropriate furniture and equipment, including tables, chairs, cubbies, cribs, napping cots/mats for infants who can climb out of a crib, bookshelves, and other activity supplies for the children. Toys are safe with no sharp edges, splinters, or points, nor made of small parts that can present a choking hazard. Drinking water is available in the classrooms via filtered water dispensers. LPAs observed all hazardous items to be inaccessible to children. There are 10 toilets and 11 sinks available for children’s use and 4 sinks and 3 toilets are designated for infant program use. A separate staff restroom and Director’s office are designated when children are ill. There are no weapons on the property. There is a pool located on the premises that is rented out to a swim lesson company. LPA verified that there was a life ring 17inches in diameter, 12ft rescue pole, water alarm that is also synced sound in the director’s office and outdoor security cameras. (Continue to page 2)
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Romelia M Castanon
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2025
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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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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304371730
VISIT DATE: 04/07/2025
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High chairs and feeding tables have broad-based legs, wood seats are in good repair and trays lock onto chairs. High chairs are made of washable, moisture-resistant material. Changing tables have at least 1” padding covered with moisture-resistant, washable material. Sides of the changing table are at least 3” high and the changing table is within arm’s reach of a sink. Diapering sink is not used for meal preparation or dishwashing. Yellow Room is equipped with a large refrigerator. Cribs meet regulatory requirements. Crib area is separated from activity space via frosted plexiglass pony wall. This barrier is at least four feet high, made of sound absorbing material but does not allow for supervision of napping children. Applicant was reminded that a staff member shall observe napping children in crib area. Sleep logs are kept in the crib area. Needs and Services Plans and Sleep Plans are kept in a cabinet near the entrance of the Yellow Room.

The outside activity space measurements based off report dated 09/16/2002 measured 7,988.87 square feet which is sufficient for the requested total capacity but the infant area that will be sectioned off can only accommodate 8 children at one time. The infant program will share the yard with the preschool component. A shared playground waiver request will be submitted to include the infant staggered schedule. The playground is enclosed by cinderblock walls that are at least 4 feet high. The equipment on the playground is age appropriate. Applicant will submit pictures of built in canopy. Water is provided via filtered water dispenser. Fire clearance was granted on 02/24/2025.


Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. (Continue to page 3)

NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Romelia M Castanon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025
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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304371730
VISIT DATE: 04/07/2025
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LPA provided the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted to Applicant.

LPA discussed the safe sleep regulations and Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed Applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed prior to the issuance of the license:
1. Waiver request and approval for shared playground

2. Photos of furnished infant room and yard canopy

3. Full review of application packet

Applicant understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

A capacity decrease for preschool and infant component addition license may be granted after the above requirements are met and a final file review is conducted.


Exit interview conducted and report was reviewed with Applicant Lacy Bonner.

End of Report
NAME OF LICENSING PROGRAM MANAGER: Monica Cuddy
NAME OF LICENSING PROGRAM ANALYST: Romelia M Castanon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025
LIC809 (FAS) - (06/04)
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