304370545-1-31-2025-06-CC-CSUN-DDFVRK-20250131154003

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370545
Report Date: 01/31/2025
Date Signed: 01/31/2025 03:40:24 PM

Document Has Been Signed on 01/31/2025 03:40 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SAUSD/GARFIELD ELEM. SCHOOL-KINDER READINESS		FACILITY NUMBER:	304370545
ADMINISTRATOR/ DIRECTOR:	SANDY ARMENTA		FACILITY TYPE:	850
ADDRESS:	850 BROWN STREET		TELEPHONE:	(714) 972-5356
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92701
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS:	DATE:	01/31/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Early Learning Specialist, Laura Barnett		TIME VISIT/ INSPECTION COMPLETED:	03:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Cynthia Sun conducted an unannounced case management inspection in response to a self-report Unusual Incident dated 1/22/2025. LPA met with Early Learning Specialist, Laura Barnett. Census was taken as follows: 2 staff supervising 19 preschool children from room #505 and 3 staff supervising 11 preschool children from room #506. All children were supervised while playing in preschool playground. A review of staff criminal clearance 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. On 01/22/25 Regional Office received a self-reported Unusual Incident Report (UIR) stating Child #1 (C1) 3.7 years old was climbing the curved latter on the playground play structure, C1 mis-stepped and landed on their private area on structure latter. Staff #1 (S1) was standing near C1 and caught C1 to prevent C1 from falling off play structure. S1 checked C1, there were no visible signs of injury, C1 and S1 walked together with the class to the restroom. S1 called C1’s parent at 9:35 AM and informed C1’s parent about the incident. Before naptime approximately 11:50 AM, Staff #2 (S2) noticed C1 started to cry and S2 asked C1 if C1 needed to go potty. C1 said no. S2 communicated with S1 and Staff #3 (S3) that C1 was crying. S2 took C1 to restroom to observe C1 closely using bathroom/potty. S2 noticed there was a small amount of blood on C1’s private area and thigh. There was no blood or blood stains in C1’s underwear. S2 wiped C1’s blood from C1’s private area and thigh and changed C1 into pull-up for nap. C1’s parent picked up C1 at 1:19 PM. C1’s parent was understanding and stated child was not feeling well. Program nurse suggested parent to take C1 to pediatric. C1 returned to facility on 1/24/25 with a doctor’s note with no restrictions. Page 1 of 2

Thuy Ho	TELEPHONE: (714) 287-8515
Cynthia Sun	TELEPHONE: (714) 300-3599
	DATE: 01/31/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/GARFIELD ELEM. SCHOOL-KINDER READINESS	FACILITY NUMBER: 304370545
	VISIT DATE: 01/31/2025

NARRATIVE

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During today's inspection, LPA inspected facility, interviewed staff, obtained facility children rosters, SAUSD C1’s Accident Report dated 1/22/25, SAUSD Monthly/Outside Safety Checklist (January 2025), C1’s Individualized Toilet Teaching and Learning Plan, C1’s Physician Note, dated 1/24/25, and photographs of preschool playground. During the inspection, LPA observed play structure equipment where C1 fell, was labeled “this equipment has been designed for users between the ages of 5 to 12 years old”. The facility is licensed to care for 48 children ages 2 through 5 years old. Based on LPA’s observation, the Play structure is not age appropriate for children in care at the facility.

California Code of Regulations, Title 22, Division 12, Chapter 1, Sections Fixture, Furniture, Equipment, and Supplies 101239 (m) is being cited on the attached LIC 809D.

An Inspection and exit interview was completed with Early Learning Specialist, Laura Barnett. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed.

Due to the Type A violation, the licensee shall post and provide copies of the report 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

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

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END OF REPORT

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Cynthia Sun	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 01/31/2025 03:40 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/GARFIELD ELEM. SCHOOL-KINDER READINESS	FACILITY NUMBER: 304370545
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

101239(m)

101239 Fixtures, Furniture, Equipment and Supplies (m) All play equipment and materials used by children shall be age-appropriate. This requirement was not met as evidence by;
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 02/03/2025
	Plan of Correction
1 2 3 4	Early Learning Specialist stated facility staff will block off the children's playground playstructure with orange cones, caution yellow tape, and position staff to ensure children will not use play structure.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Thuy Ho	TELEPHONE: (714) 287-8515
Cynthia Sun	TELEPHONE: (714) 300-3599
	DATE: 01/31/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC809 (FAS) - (06/04)

Page: 2 of 3