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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370413
Report Date: 10/11/2019
Date Signed: 10/11/2019 11:20:23 AM

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:SANTA ANA USD/WILSON PREKINDERGARTENFACILITY NUMBER:
304370413
ADMINISTRATOR:ALVAREZ, RITAFACILITY TYPE:
850
ADDRESS:1317 NORTH BAKER STREETTELEPHONE:
(714) 564-8100
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:48CENSUS: 27DATE:
10/11/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Veronica Berber-Aceves (Program Coordinator) TIME COMPLETED:
11:45 AM
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An unannounced Case Management (incident) inspection was conducted today by Licensing Program Analyst (LPA) Ketki Desai. Upon arrival to the school office, LPA was guided to the K-1 and K-2 rooms where two Pre-Kinder classrooms are licensed by the Department.
The inspection was conducted following an incident reported by the facility, where a child alleged being yelled and hit by the classroom staff.
Prior to the arrival to the facility, LPA contacted the authorized representative of Child # 1, to conduct the needed interview but the request was denied. The child was a new admit and attended the class only for a day. Currently the child is not enrolled in the program.
Licensing Program Analyst conducted interviews and obtained written declarations from the attending staff members in classroom # K-1, where the child was for one day, also received additional pertaining documents from the Program Coordinator and the text message conversation with the staff and the parent.
Staff files were reviewed and the classrooms were toured. Staff - Teacher ratio was observed and the staff present in both the classrooms are live scanned through the Department of Education.

Based on the interviews conducted, documentation received on today's site case management visit.
No deficiencies were cited for this case management inspection.

An exit interview was conducted with the Program Coordinator.

Report was reviewed and discussed. The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. The first level appeal is to regional manager, address is above on the report. The Notice of Site Visit was posted. 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. This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
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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