300600222-10-4-2022-06-CC-NKTN-CJVQQD-20221004122211

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600222
Report Date: 10/04/2022
Date Signed: 10/04/2022 12:22:18 PM

Document Has Been Signed on 10/04/2022 12:22 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	FOOTHILLS PRESCHOOL		FACILITY NUMBER:	300600222
ADMINISTRATOR:	CAREY, MARGARET		FACILITY TYPE:	850
ADDRESS:	19211 DODGE AVENUE		TELEPHONE:	(714) 573-7723
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	60	CENSUS: 32	DATE:	10/04/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Marci Carey, Director		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/04/2022, Licensing Program Analyst (LPA) Nguyen Tran conducted a case management inspection to follow up on a self-report unusual incident that was submitted to Community Care Licensing Regional Office on 09/28/2022. It was reported by Marci Carey, Director that on 9/8/22, Teacher Gizelle Ceja observed Child#1 come up to another child from behind and tried to hump another child. On 9/8/22 C1 exposed himself to a group of 3 children in the playground. Director stated after 9/8/22 child #1 continued to expose himself to children in the playground a few more times. On 9/21/22 Director spoke with parents regarding child’s behavior and they didn’t know why child was behaving like that. On 9/23/22 Director spoke with C1 and addressed the concerns about C1's behaviors C1 disclosed that C1's sibling does it to C1. Staff kept documentation and Director called to CPS to report. During today's inspection a tour of the facility was conducted. There were 32 preschool children and 8 staff in 4 different classrooms. A review of staff 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. During today's inspection, LPA interviewed staff members and reviewed C1's file. During the interviews, all 6 interviewed staff provided consistent statements regarding the incident as followed. Director stated that staff were made aware of the incident and providing more supervision for C1 in the classroom and on the playground. Director had met with C1 and with C1's parents and discussed her concerns of child's behavior and developed a plan to manage child's behavior. Director also made a call to Child Protective Service as a mandated reporter. LPA also reviewed C1's files and observed incident reports being documented and kept in records. All interviewed staff reported that they are providing supervision for C1 closely, intervening as needed, informing Director and keeping document if there are incident with C1. Based on LPA’s interviews conducted with staff and record reviews, no deficiency was observed in accordance with California Code of Regulations. (Continue next page)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FOOTHILLS PRESCHOOL	FACILITY NUMBER: 300600222
	VISIT DATE: 10/04/2022

NARRATIVE

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(Page 2 of Report)

Appeal Rights were explained. The Director was provided a copy of appeal rights (LIC 9058 01/16) 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. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Marci Carey.

(End of Report)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC809 (FAS) - (06/04)

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