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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370547
Report Date: 01/22/2025
Date Signed: 01/22/2025 12:07:52 PM

Document Has Been Signed on 01/22/2025 12:07 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/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAMFACILITY NUMBER:
304370547
ADMINISTRATOR/
DIRECTOR:		MEDRANO, PATRICIAFACILITY TYPE:
850
ADDRESS:1405 FRENCH STREETTELEPHONE:
(714) 564-2200
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 18DATE:
01/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Early Learning Specialist, Laura BarnettTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Cynthia Sun conducted an unannounced case management inspection in response to a self-report Unusual Incident dated 1/17/2025 LPA met with Early Learning Specialist, Laura Barnett Census was taken as follows: 3 staff supervising 18 preschool children in Room #30 and 3 staff supervising 12 preschool children in Room #31.

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 1/17/25, Regional Office received a self-reported Unusual Incident Report (UIR) stating that at arrival time at about 8:01AM Parent #1 (P1) spoke with Staff #1 (S1) and Staff #2 (S2), P1 stated Child #1 (C1) came home with 2 pills that P1 thinks C1 got pills from school. P1 stated that at home P1 took C1’s water bottle out of C1’s backpack and found two pills, P1 asked C1 who gave C1 pills and C1 (nonverbal) pointed in the direction to the school. P1 asked C1 “did they give it to you at school?” P1 stated that C1 moved C1's head left to right. S4 asked P1 if anybody in the home takes medication and P1 stated only A1, but those are not A1’s medication, and we keep medication out of C1’s reach. S4 also asked if P1 took C1 to doctor or hospital, P1 stated that P1 didn’t see C1 ingest anything or C1’s behavior change so P1 did not seek medical attention. S1 observed that there was a tag on the backpack that said Goodwill. S4 informed P1 that possibly pills could of come from Goodwill. P1 stated no “l shook backpack out and washed it and there were no pills in the backpack.” C1 returned to the program the week of 1/17/25.

During today's inspection, LPA inspected facility, interviewed staff, child, obtained pills found in C1's, backpack and obtained facility children and staff roster.

Due to insufficient information available at this time, the reported incident needs further investigation.



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Thuy HoTELEPHONE: (714) 287-8515
Cynthia SunTELEPHONE: (714) 300-3599
DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAM
FACILITY NUMBER: 304370547
VISIT DATE: 01/22/2025
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No deficiency was observed during today's inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The Early Learning Specialist, was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The director was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door.








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End of Report

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Cynthia SunTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
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