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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270874
Report Date: 09/30/2021
Date Signed: 09/30/2021 03:12:04 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:DREAM LAND PRESCHOOLFACILITY NUMBER:
304270874
ADMINISTRATOR:YOUN, HEE JOONFACILITY TYPE:
850
ADDRESS:5101 WALNUT AVENUETELEPHONE:
(949) 551-3367
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:128CENSUS: 61DATE:
09/30/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Hee Joon Youn, Director TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mila Quinto conducted a case management inspection in response to a self-reported incident on 9/24/21. LPA and director, Hee Joon Youn toured the facility inside and outside and the floor and yard plan (LIC 999) were verified. Census was taken and the overall census observed were 12 staff and 61 preschool children. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 9/24/21, the facility self-reported that on 9/23/21 at 4:18pm, there were 2 staff in the classroom during the time of the incident. One staff had the children in circle time while the other staff was taking a child one by one out of the circle time to take individual pictures.

LPA interviewed the 2 staff members who were in the classroom during the incident. The 2 staff members stated there were a total of 13 children in the classroom during the incident. One staff had 12 children in circle time on the opposite side of the room while the other staff would take one child at a time to the other side of the room for individual photos. The staff set up the backdrop for the photos against the wall and placed a chair to elevate the child for the picture. The child was leaning against the wall as the chair was moving forward and child fell on his right arm. The staff was infront of the child taking the child’s photo. LPA reviewed the sign in/sign out sheet for 9/23/21 and confirmed there were 13 children in care in the classroom.

Based on staff interviews, records review, this incident, where a child fell from the chair is is deemed to be an accident.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mila QuintoTELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: DREAM LAND PRESCHOOL
FACILITY NUMBER: 304270874
VISIT DATE: 09/30/2021
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No deficiencies are cited during this inspection.

Exit interview was conducted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mila QuintoTELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC809 (FAS) - (06/04)
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