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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600313
Report Date: 09/25/2019
Date Signed: 09/25/2019 09:30:12 AM

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:FIRST BAPTIST CHURCH VALLEY DAY PRE SCHOOLFACILITY NUMBER:
300600313
ADMINISTRATOR:HALL, AMYFACILITY TYPE:
850
ADDRESS:17415 MAGNOLIA AVENUETELEPHONE:
(714) 847-4844
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:80CENSUS: 50DATE:
09/25/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Acting Director Gabriel HallTIME COMPLETED:
10:00 AM
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An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Ho. The purpose for today’s inspection was to evaluate the facility for a capacity increased. LPA met with acting director, Gabriel Hall. Director arrived shortly to meet LPA. Census was taken as follow: 44 preschool children and 6 toddlers option children with 10 staff members including the acting director. Facility is currently licensed for 12 toddler option children and seeking to increase capacity to 18 toddler option children. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today's inspection, director decided to withdraw the application to increase toddler option capacity.

After a tour of the center, no deficiency was observed .

Exit interview conducted. Notice of Site Visit was posted. Director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post it will result in civil penalties of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182).
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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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