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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300614039
Report Date:
08/08/2019
Date Signed:
08/08/2019 01:08:29 PM
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:
ABC DEVELOPMENT PRESCHOOL #3
FACILITY NUMBER:
300614039
ADMINISTRATOR:
CALVILLO, LISA
FACILITY TYPE:
840
ADDRESS:
9972 GRAHAM ST
TELEPHONE:
(714) 821-4222
CITY:
CYPRESS
STATE:
CA
ZIP CODE:
90630
CAPACITY:
60
CENSUS:
28
DATE:
08/08/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Janice LeBrun
TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yesenia Villa conducted an unannounced case management visit for the purpose of providing an amended report that was provided on 07/31/19 for capacity increase in the school age program. LPA Villa met with Ms. Janice LeBrun and census was obtained. There were 28 children present with 6 staff members. All personnel present have obtained criminal background and fingerprint clearance prior to working in the facility.
A copy of the amended report was provided to Ms.Janice LeBrun on this date with the corrected facility to school age #300614039 from #300614038.
A notice of site visit was provided and Licensee was advised that failure to post for 30 days can result in a $100.00 civil penalty fee. Exit interview conducted and Licensee was provided with appeal rights. Advised to appeal any citation it must be done within 15 days of citation and submitted with supporting documents to our Regional Manager Bertha Manzanarez.
SUPERVISOR'S NAME:
Judy Hanson
TELEPHONE:
(714) 703-2807
LICENSING EVALUATOR NAME:
Yesenia Villa
TELEPHONE:
(714) 293-9465
LICENSING EVALUATOR SIGNATURE:
DATE:
08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/08/2019
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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