304370547-2-5-2025-06-CC-CSUN-DDLVFW-20250205152436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370547
Report Date: 02/05/2025
Date Signed: 02/05/2025 03:24:45 PM

Document Has Been Signed on 02/05/2025 03:24 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 PROGRAM		FACILITY NUMBER:	304370547
ADMINISTRATOR/ DIRECTOR:	MEDRANO, PATRICIA		FACILITY TYPE:	850
ADDRESS:	1405 FRENCH STREET		TELEPHONE:	(714) 564-2200
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92701
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS:	DATE:	02/05/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Early Learning Specialist, Laura Barnett		TIME VISIT/ INSPECTION COMPLETED:	03:25 PM

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Licensing Program Analyst (LPA) Cynthia Sun conducted an unannounced follow-up case management inspection in response to a self-report Unusual Incident dated 1/17/25. LPA met with Early Learning Specialist, Laura Barnett and informed purpose of today’s case management initiated on 1/22/25. Census was taken as follows: 3 staff supervising 14 preschool children in Room #30 and 3 staff supervising 3 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 on 1/16/2025, at approximately 8:00 AM Parent #1 (P1) spoke with Staff #1 (S1) and Staff #2 (S2), because

P1 ‘s Child #1 (C1) came home with 2 pills that P1 thinks C1 got pills from school. P1 stated that at home when P1 took C1’s water bottle out of C1’s backpack P1 found two pills, inside in the bottom of backpack. P1 asked C1 who gave C1 the 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. Staff #4 (S4) asked P1 if anybody in the home takes medication and P1 stated only Adult #1 (A1), but those are not A1’s medication, and they keep A1’s medication out of C1’s reach. S1 observed that there was a tag on the backpack that said Goodwill. S4 informed P1 that possibly pills could have come from Goodwill. P1 stated “no, l shook backpack out and washed it and there were no pills in the backpack.”

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Thuy Ho	TELEPHONE: (714) 287-8515
Cynthia Sun	TELEPHONE: (714) 300-3599
	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAM	FACILITY NUMBER: 304370547
	VISIT DATE: 02/05/2025

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LPA interviewed Staff #1 (S1), Staff #2 (S2), and staff #3 and all staff provided the same information where facility medication was kept. All staff stated medications are kept inside the cabinet next to the computer locked with key. 2 of 3 staff stated they have only administered asthma inhaler medication to facility children in the last 3 months. S3 stated that despite being trained to administer medication, S3 does not administer medication to facility children.

LPA observed that facility children medication is kept in locked cabinet next to teacher’s desk. LPA confirmed facility medication cabinet is locked making medication inaccessible to children in care and only asthma inhaler medication is stored in medication cabinet inaccessible to children. Facility medication did not have pills to administer to children.

LPA interviewed P1 and Adult #1 (A1). P1 stated P1 hand washed and aired dried backpack. P1 stated that when P1 asked C1 if pills were given to C1 at school, C1 moved head from side to side. P1 stated A1 takes medication and provided photos of A1’s medication. LPA observed photos and one of A1’s medication pills was similar to one of the pills found inside the backpack.

Based on LPA’s interviews and observation, it was determined the facility was in compliance with regulation and no citation was being issued.

Exit interview conducted and report was reviewed with Early Learning Specialist, Laura Barnett. Notice of Site Visit was posted and must remain posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.

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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Cynthia Sun	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAM	FACILITY NUMBER: 304370547
	VISIT DATE: 02/05/2025

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Appeal Rights were explained. The licensee was provided with a copy of the appeal rights (LIC 9058 01/16) 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. First level appeals should be sent to the regional manager to the address listed above.

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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: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

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