<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204569
Report Date: 02/05/2020
Date Signed: 02/06/2020 08:22:24 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:HANVEY, DEBRAFACILITY NUMBER:
304204569
ADMINISTRATOR:HANVEY, DEBRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 771-2236
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY:14CENSUS: 8DATE:
02/05/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Debra HanveyTIME COMPLETED:
01:00 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
A Plan of Correction inspection was conducted by Licensing Program Analyst (LPA) Han Jungmi in response to an A violation issued during an Inspection on 1/29/2020. During the inspection on 1/29/2020, the facility was issued an A violation for absence of supervision. LPA observed 6 children were playing outdoor area without supervision for at least 4 minutes at 10:15AM. LPA also observed the outdoor play area fence has been broken and patio door to hear outdoor area children from indoor has been closed. This was an immediate threat to the children's health and safety, and was issued as A violation during the inspection on 1/29/2020. LPA Han received the statement from licensee regarding facility supervision policy and procedure to ensure that children in care are supervised at all times on 1/31/2020.

During today's Plan of Correction inspection, a census of children in care was taken, reviewed children’s files and staff files, and a physical plant inspection was conducted. There was a total of 2 infants and 6 preschool age children and 2 staff including licensee observed. 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 or exemptions. LPA observed fence has been fixed.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted. The report was reviewed and discussed. Notice of Site Visit was posted during the visit. The Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The facility was provided a copy of their appeal rights (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. The facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov This report is to be on file and accessible for public review at the facility for at least 3 years.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1