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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600324
Report Date: 12/09/2021
Date Signed: 12/09/2021 12:20:34 PM

Document Has Been Signed on 12/09/2021 12:20 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:PRESCHOOL AT THE FOUNTFACILITY NUMBER:
300600324
ADMINISTRATOR:STEPHANIE PARSONSFACILITY TYPE:
850
ADDRESS:18225 BUSHARD STREETTELEPHONE:
(714) 968-2834
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 27DATE:
12/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Stephanie Parsons, director TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Case Management Incident inspection, in response to an Unusual Incident Report submitted to the Licensing office on 12/3/21. LPA and the facility representative toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. Census was taken in individual classrooms. The overall census observed was 27 preschool children with 7 preschool staff. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staff to child ratios. 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 was submitted to the Licensing office on 12/3/21 detailing that an adult (see Confidential Names List LIC811) stated to a staff #1 that a child, child #1, stated to them that a staff #4 may have violated their personal rights by pulling on their hair. During today's inspection, LPA Valencia conducted a physical plant inspection of the facility and observed the classrooms and interviewed 7 staff and 4 children. It was determined from the information available to LPA during the inspection, that the facility nor staff #4, did not violate Title 22 Regulations of children's personal rights, at all related to this incident. A printout of Title 22 Regulations of Personal Rights was reviewed and a printout of them was provided for the director.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. An exit interview was completed with facility representative and The report was reviewed and discussed. The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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