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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313452
Report Date: 04/28/2023
Date Signed: 04/28/2023 05:45:48 PM


Document Has Been Signed on 04/28/2023 05:45 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:MIN, JIFACILITY NUMBER:
304313452
ADMINISTRATOR:MIN, JIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 397-9383
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY:14CENSUS: 12DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Ji MinTIME COMPLETED:
06:00 PM
NARRATIVE
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On Friday April 28 of 2023 at 12:46 pm, Licensing Program Analyst (LPA) A. Silva conducted an unannounced Required – 1 Year inspection assisted by licensee Ji Min. Upon arrival, the licensee and one teacher had 12 clients in care, including 2 infants and 10 preschool children. An on-site Facility Personnel Report Summary review showed that all facility residents, staff, or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions. Two adults, including the licensee, and 2 minors are currently living in the home, according to the licensee. The facility was operating within the licensed capacity.

INDOOR INSPECTION. The LPA inspected the indoor FCCH (family child care home) area identified in the Facility Sketch LIC999 and areas accessible to clients. At 12:52 pm, the LPA observed three (3) children napping in play yard. Two of them—C1 and C2— were infants (24 months or younger). The LPA observed blankets and pillows in C1’s and C2’s play yards. LPA informed the licensee that safe sleep regulations (CCR 102425) require cribs/play yards to be free from loose articles and objects (see attached 809D). The licensee removed loose articles from inside the paly yard. LPA inquired about sleep logs. The licensee provided sleep logs for C1 and C2 for April 26, 27, and 28 of 2023. C3 turned 2 years-old on 4/27/23. The LPA inquired about C3’s sleep logs. The licensee did not provide them. LPA informed the licensee that per safe sleep regulations, providers must check and document infant sleep every 15 minutes and keep records for a minimum of three years.

Off-limits areas were inaccessible to clients in care by means of child gates, at the time of inspection. The facility is a Two-story home. The child care area, which is accessed through the front door, consists of two rooms left to the main entrance and a section the backyard, which are adjacent to the kitchen.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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Document Has Been Signed on 04/28/2023 05:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, records review, and interview, the licensee did not comply with the section cited above in 1 out of 1 fire extinguisher in the day care, which poses an immediate health, safety or personal rights risk to persons in care. The licensee stated that she has never serviced the fire extingyisher.
POC Due Date: 04/29/2023
Plan of Correction
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The licensee stated she will buy a new fire extinguisher and send proof of correction to LPA by the due date above via email at archibaldo.silva@dss.ca.gov
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in 2 out of 2 infants in care, which poses an immediate health, safety or personal rights risk to persons in care. The licensee stated that she was not aware play yards had to be free of loose articles.
POC Due Date: 04/29/2023
Plan of Correction
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The licensee removed all loose articles and objects from the play yards while the LPA was still in the facility. The licensee stated she will have an infant safe sleep regulations with teachers on Monday and provide proof via email to LPA by monday before the end of the day.
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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/28/2023 05:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, records review, and interview, the licensee did not comply with the section cited above in 1 out of 1 mandated reporter certificates, which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee stated she was not awre she had to renew the mandated reporter training.
POC Due Date: 05/19/2023
Plan of Correction
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The licensee stated that she will complete the mandated reporter training and provide proof of completion by the due date above via email to LPA at archibaldo.silva@dss.ca.gov
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, records review, and interview, the licensee did not comply with the section cited above in 1 out of 3 infants, which poses/posed a potential health, safety or personal rights risk to persons in care. The licensee stated that she did not have sleep logs for C3 who turned 2 years of age on 4/27/23.
POC Due Date: 05/19/2023
Plan of Correction
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The licensee stated she will continue to carry out and document sleep logs for all infants in care and provide copies to LPA via email by the due date above.
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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452
VISIT DATE: 04/28/2023
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The facility was equipped with working carbon monoxide and smoke detectors and working telephone service. The fire extinguisher did not meet statutory and State Fire Marshall standards as required by regulations (CCR 102417) because it was last serviced in 2016 (See attached 809D). The licensee agrees to maintain telephone service in the home when clients are in care. Hours of operation are 8 am to 5:30 pm Monday through Friday. The licensee is aware that each FCCH shall conduct fire drills and disaster drills at least once every six months. A record review shows that the last drill was documented on 12/1/23. The fireplace was blocked with furniture and is inaccessible to clients in care.

The licensee stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care. No poisons or other items that could pose a danger to clients were observed during the inspection. Clients nap on cots. According to the licensee, beddings are stored individually and washed weekly by the parents. The facility provides age-appropriate toys, play equipment, and materials for the clients served.

ON-SITE FOOD PREPARATION: The licensee provides meals and snacks to the children. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. Filtered drinking water is available to clients in care. Bottles are labeled with children’s names. The LPA observed that the facility’s floors, equipment, furniture, and clients’ bathrooms were clean and in good repair.

OUTDOOR INSPECTION: The playground was enclosed by a fence. The outdoor equipment and toys were in good repair and free of sharp edges. At the time of inspection, the surface of the outdoor activity area was well-maintained and free of any observable hazards. There were no bodies of water (in-ground pool/ jacuzzi/ community pool/water fountain) in the facility at the time of inspection.

PERSONNEL RECORDS: The LPA reviewed two files out of the two staff who were present during the inspection. The licensee’s mandated reporter expired in 2018. The licensee’s Pediatric CPR/First Aid certification expires on 8/2023.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452
VISIT DATE: 04/28/2023
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CHILDRENS’ RECORDS: The licensee has a current roster of clients. The LPA reviewed five (5) children files of children who were present during the inspection. The roster shows there are two (2) infants enrolled in the FCCH. LPA reviewed LIC 9227 Individual Infant Sleeping Plan and 15-minute check logs for infants enrolled. As noted above, the licensee is out of compliance (see attached 809D).

The Incidental Medical Services (IMS) policy was discussed. A link to PIN 22-02-CCP was provided here: PIN 22-02-CCP: Best Practices Related to the Provision of Incidental Medical Services in Child Care Centers and Family Child. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
The licensee understands that she shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a qualified substitute adult to care for and supervise the children during her absence [A qualified substitute adult is an adult that has criminal record and child abuse index clearances, immunizations, and current Pediatric CPR/First Aid and Mandated Reporter training]. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day, in accordance with Section 102417 of the California Code of Regulations. The licensee understands that children are not to be left alone in parked vehicles.

The licensee understands that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452
VISIT DATE: 04/28/2023
NARRATIVE
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The licensee understands that a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year, in accordance with Section 1597.622 of the Health and Safety Code.

The licensee understands it is her responsibility to review the Provider Information Notices (PIN) found on the CCLD website above. If not yet registered, the licensee agrees to register to receive quarterly updates via email at childcareadvocatesprogram@dss.ca.gov or online at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe

The LPA discussed the following resources with the licensee:
US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY)
Commonly Asked Questions about Child Care Centers and the ADA link: http://www.ada.gov/childqanda.htm
CaSocialService YouTube Guardian Webinar “All Providers Webinar 11/15/22” link https://youtu.be/HnfxXV92eQ0
CaSocialService YouTube Guardian Webinar “All Providers Webinar 12/20/22” link https://youtu.be/WNc1kYmlW9s
Guardian information link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian
CCLD link: www.cdss.ca.gov/inforesources/community-care-licensing
CPSC (United States Consumer Product Safety Commission) link: https://www.cpsc.gov/
A copy of the CDSS Lead Information Brochure was explained and provided to the licensee

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452
VISIT DATE: 04/28/2023
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LPA reviewed the following safe sleep best practices with the licensee:
  1. Always place infants 12 months and younger on their backs to sleep
  2. Use only a tight-fitting sheet on the crib or play yard mattress
  3. Do not hang any items from the crib or above the crib
  4. Keep all items including blankets, pillows, and stuffed dolls out of the crib or play yard
  5. Pacifiers may be used only if they do not have items attached to them and there is no recall
  6. Infants should not be swaddled or have any items covering them while sleeping
  7. The temperature of the room should be comfortable enough for a lightly clothed adult
  8. Complete Individual Sleeping Plan LIC9227 for infants 12 months and younger
  9. Conduct and document the 15-minute checks for all infants.
  10. CDSS Safe Sleep link: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.
  11. A brochure of “what does a safe sleep environment look like?” was provided.

The facility was NOT in compliance. Violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Operation of A Family Child Care Home 102417(g)(1), Infant Safe Sleep 102425(b), Administration of Child Day Care Licensing 1596.8662(b)(1), Infant Safe Sleep 102425(j)(2)(D).

LPA A. Silva informed licensee Ji Min that this licensing report dated 04/28/2023 documents two (2) “Type A” citation(s). Type A citations must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed licensee Ji Min that copies of the report must be provided to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MIN, JI
FACILITY NUMBER: 304313452
VISIT DATE: 04/28/2023
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Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with licensee Ji Min.

The LPA conducted an exit interview and reviewed the report with the licensee. The “Notice of Site Visit” was provided and the licensee shall post it for 30 days. The Appeal Rights were explained. The licensee received a copy of the Appeal Rights (LIC 9058 01/16), their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the Regional Manager to the address listed above.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey to share your inspection experience. If you have any questions regarding the process or tools used during the inspection, email them to inspectionprocess@dss.ca.gov. For more information about the inspection, its tools, and methods visit www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
End of Report.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023
LIC809 (FAS) - (06/04)
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