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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270683
Report Date: 06/25/2019
Date Signed: 06/25/2019 01:16:20 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:MAOF CHILD CARE CENTER-SANTA ANAFACILITY NUMBER:
304270683
ADMINISTRATOR:PANDURO LEONORFACILITY TYPE:
850
ADDRESS:2033 WEST EDINGER STREETTELEPHONE:
(714) 557-2686
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:50CENSUS: 22DATE:
06/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Staff Development Supervisor, Angela LuceroTIME COMPLETED:
01:45 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
An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Nguyen in response to a self reported incident dated 6/18/2019. Present during today’s inspection was Staff Development Supervisor, Angela Lucero and Interim Site Supervisor, Eva Hernandez. Assistant Program Director, Norma Amezcua arrived during the inspection. LPA observed 22 preschool age children, and 6 preschool staff. During today's inspection it was determined that the facility was operating within the licensed capacity and within compliance of staffing ratios. A review of adult records 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 today's inspection, LPA interviewed 4 staff members, 6 children, reviewed children’s file and conducted a physical plant inspection. Based on the information gathered from the interviews conducted, it was determined that the facility didn’t report another incident happened 6/14/2019 at approximately 11:20 am, child #2 went through outside back open door to go to another classroom (preschool room) which is right next door. Staff in the first classroom (child care room) were not aware of child #2 was missing until the second classroom teacher brought the child #2 back.

California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101229(a)(1) and 101212(d) are being cited on the attached LIC 809D. A civil penalty of $500 has been assessed during today's inspection.

This report cites Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.



Continued on Page 2
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MAOF CHILD CARE CENTER-SANTA ANA
FACILITY NUMBER: 304270683
VISIT DATE: 06/25/2019
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
26
27
28
29
30
31
32
Page 2

Exit interview was conducted with Staff Development Supervisor, Angela Lucero. Notice of Site Visit was posted during the inspection. Facility representatives 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. Facility representatives was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MAOF CHILD CARE CENTER-SANTA ANA
FACILITY NUMBER: 304270683
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2019
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The facility representatives stated the child care staff will have a training on supervision including visual obsrevation. A signed acknowledgment email to LPA Nguyen (Cindy.Nguyen@dss.ca.gov) by 06/26/19.
8
9
10
11
12
13
14
Based on interviews conducted, it was determined child #2 went through outside back open door to go to another classroom (preschool room) which is right next door.
This poses an immediate health and safety risk to children in care. A civil penalty of $500 has been assessed during today's inspection.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: MAOF CHILD CARE CENTER-SANTA ANA
FACILITY NUMBER: 304270683
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2019
Section Cited
CCR
101212(d)
1
2
3
4
5
6
7
101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center...by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information...such event. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The facility representatives will send a statement acknowledging the importance of reporting requirements and understanding complying with this section to our office in the future. A signed acknowledgment statement will be sent to LPA Nguyen (Cindy.Nguyen@dss.ca.gov) by 06/26/19.
8
9
10
11
12
13
14
Based on interviews conducted, it was determined that the facility didn’t report an incident happened on 6/14/2019 at approximately 11:20 am, child #2 went through outside back open door to go to another classroom which is right next door. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4