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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370518
Report Date: 10/30/2020
Date Signed: 11/05/2020 10:36:39 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:LOVE 2 LEARN PRESCHOOLFACILITY NUMBER:
304370518
ADMINISTRATOR:J. MARTINEZ & A.WIJEMANNEFACILITY TYPE:
850
ADDRESS:1200 WEST 17TH STREETTELEPHONE:
(714) 834-1966
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY:74CENSUS: 54DATE:
10/30/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Jose Martinez, Director TIME COMPLETED:
01:30 PM
NARRATIVE
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Tele-Inspection due to COVID-19 State of Emergency

A Case Management inspection conducted on this by Licensing Program Analyst (LPA) Nguyen to follow up with one of the incidents occurred at the facility. LPA spoke with Director Jose Martinez on the telephone. LPA Nguyen notified the Director that due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing a tele-investigation would be conducted. Director stated that 54 preschool age children with 6 staff including the director. 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 also addressed the Reporting Requirement and Health Related issues. Through the course of inspection, LPA determined that the facility staff failed to report an injury occurred on June 4th, 2020 when the child fell at the facility and hurt her forehead. The child was taken to the ER by the mother at the end of the day and got 5 stiches on the child's forehead. Director was aware that the child was taken into the ER and failed to report the incident to licensing office in the timely manner.
The facility was not incompliance with regulations during today's inspection.
Exit interview was conducted. The Notice of Site Visit was not posted due to tele-investigation Covide-19 State of Emergency. 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.
Web address for downloading forms or regulations was provided as (http://ccld.ca.gov/PG411.htm).
The link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
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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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: LOVE 2 LEARN PRESCHOOL
FACILITY NUMBER: 304370518
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2020
Section Cited

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Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events ..., a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours … include the following: Any injury to any child that requires medical treatment.
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This requirement is not met as evidence by: Based on Interview and record review. On 06/04/2020, a child fell at the facility and mother informed director that she took the child to hospital. Director failed to report the incident to licensing office in a timely manner. This poses a potential risk to the health and safety of the children in care.
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He will complete the Unusual Incident Report for that incident and send it to LPA Nguyen via email by 11/05/2020. Director will make sure to report any unusal incidents in the future to Licensing office.


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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: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2020
LIC809 (FAS) - (06/04)
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