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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270976
Report Date: 02/26/2020
Date Signed: 02/26/2020 05:10:27 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:KIDS ADVENTURE LEARNING CENTERFACILITY NUMBER:
304270976
ADMINISTRATOR:SANCHEZ, AURORAFACILITY TYPE:
840
ADDRESS:1834 VALENCIATELEPHONE:
(714) 525-7377
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:17CENSUS: 10DATE:
02/26/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Director Aurora Sanchez TIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Barajas conducted an inspection of this facility in response to a self reported unusual incident received in our office on 02/12/2020, and phone call on 02/13/2020. The facility reported a child sustained an injury to the chin, injuring mouth and bottom teeth.

LPA toured the facility inside and outside and observed 8 school age children and 2 school age staff members in green room. 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.

During today's inspection LPA spoke with the director, a child and another staff member and obtained photographs of the playground where the incident occurred, sign in and sign out sheets, copies of cpr cards, and ouch report. Children named in the incident report were not present during today's inspection. LPA will return at a later date to conduct interviews regarding the incident.

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

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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 director 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 at the address listed above.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 292-8628
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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