304205434-3-7-2025-06-CC-OMEA-DEJUB8-20250307142554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304205434
Report Date: 03/07/2025
Date Signed: 03/07/2025 02:26:05 PM

Document Has Been Signed on 03/07/2025 02:26 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	HOLGUIN, KELLY		FACILITY NUMBER:	304205434
ADMINISTRATOR/ DIRECTOR:	HOLGUIN, KELLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 963-3307
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	03/07/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Kelly Holguin		TIME VISIT/ INSPECTION COMPLETED:	02:30 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	On 3/7/2025 an annual inspection was conducted at the facility by Licensing Program Analyst (LPA) Olivia Meza. Upon arrival, LPA met with Licensee Kelly Holguin and was provided a tour of the home. There was one adult staff and one licensee with 3 (three) preschool 3 (three) infants. Licensee stated that facility day care hours are Monday through Friday 7:30am to 5:30pm. During today’s inspection, LPA Meza and licensee toured the inside and outside areas of the facility. Off limits areas are made inaccessible by means of safety gates. The childcare area consists of the daycare room, bedrooms for napping, and the backyard area. There was a carbon monoxide, smoke detector, and fire extinguisher that met statutory requirements. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. During today’s inspection LPA verified there is a working (cellular) phone service. Licensee was instructed that children must be supervised at all times. Children’s records for 5 children during LPA’s inspection were reviewed. The licensee’s Pediatric CPR/First Aid certification is current and expires 9/21/2026. The most recent Emergency disaster drill was conducted on 03/01/2025 and is conducted every six months. LPA discussed the safe sleep regulations with licensee, Kelly Holguin and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. (continue to page 2)

Martha Malane	TELEPHONE: (714) 795-0859
Olivia Meza	TELEPHONE: (714) 293-9315
	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HOLGUIN, KELLY	FACILITY NUMBER: 304205434
	VISIT DATE: 03/07/2025

NARRATIVE

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(page 2)
LPA also informed Licnsee, Kelly Holguin of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Childcare Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

CCLD website www.cdss.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. Licensee does/does not have lead training Certificate. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at

(continue to page 3)

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Olivia Meza	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HOLGUIN, KELLY	FACILITY NUMBER: 304205434
	VISIT DATE: 03/07/2025

NARRATIVE

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(page 3)
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 during today’s inspection.

Appeal Rights were explained, and licensee was provided a copy. All appeals must be in writing and received by the Regional Office within 15 business days.
Notice of site visit was provided and must be posted for 30 days. Exit interview was conducted.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

end of report.

SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Olivia Meza	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025

LIC809 (FAS) - (06/04)

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