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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606107
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:21:15 PM


Document Has Been Signed on 10/25/2023 02:21 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:IRVINE UNITED CHURCH EARLY CHILDHOOD CENTERFACILITY NUMBER:
300606107
ADMINISTRATOR:ROSALES, IRMAFACILITY TYPE:
850
ADDRESS:4915 ALTON PARKWAYTELEPHONE:
(949) 733-0228
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:61CENSUS: 40DATE:
10/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Irma RosalesTIME COMPLETED:
02:40 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Dean Thompson and Karen Navar conducted a case management investigation to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 10/12/2023. It was reported by Director Irma Rosales via fax. According to the report, the unusual incident occurred on 10/12/2023 regarding a disgruntled parent.

Upon arrival, LPA's met with Director who then guided LPA's on a tour of the facility. Census was taken as follows: 8 preschool staff including director with 32 preschool children and 8 toddlers. A review of staff criminal clearance 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 or exemptions.

During the investigation, LPA reviewed child file, documentation, and conducted an interview with staff. The incident that occurred on 10/12/2023 does not require further investigation. Facility reported the incident within 24 hours and is found to be in compliance with Title 22 Division 12 reporting requirements.

Based on LPA interview with staff and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations.

Exit interview conducted and report was reviewed with Director Irma Rosales. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights discussed. Director was provided a copy of their 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.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean ThompsonTELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
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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