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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370580
Report Date: 08/20/2024
Date Signed: 08/20/2024 03:40:43 PM

Document Has Been Signed on 08/20/2024 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:APPLE TREE LEARNING ACADEMYFACILITY NUMBER:
304370580
ADMINISTRATOR/
DIRECTOR:
SUK, JUNG H.FACILITY TYPE:
850
ADDRESS:2338 EAST WAGNER AVENUETELEPHONE:
(714) 284-0706
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 10DATE:
08/20/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Suk JungTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 8/20/2024, Licensing Program Analyst (LPA) A. Silva conducted a Case Management – Deficiencies due to deficiencies observed during a visit. Upon arrival, the LPA met with Director Suk Jung. An on-site Facility Personnel Report Summary review indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Census was 10 children. The facility was operating within ratios and capacity.

During an initial 10-day visit continuation, the LPA informed the licensee he would step outside to pick u the printer to finalize the visit. The LPA walked from school age classroom to the lobby where the parents sign in/out children. In the lobby, the LPA observed C1 sitting down calmly in front of the restroom door. The LPA sat next to the child asking what C1 was doing. C1 said they wanted to go play outside; C1 stood up and looked out through the door toward the playgrownd. The LPA asked, where is your teacher. The child did not answer. The LPA asked who is in the restroom. C1 named another child. At this point the director stepped into the lobby expressing surprise to see C1 alone there with the LPA.

The LPA conducted an interview about the deficiency with Director Suk. Director Suk was upset and expressed this has never happened in her school. The Director admitted it was her fault and disclosed that she thought C1 was with Staff 2 in the classroom, with the rest of the children, because that is their routine after nap. The Director admitted that somehow she missed C1 when she was tying the children’s shoe leaces as they woke up from a nap.

The LPA and Director Suk determined that the child must have been sitting in the lobby for about 5 to 10 minutes without supervision based on how long it had passed since the rest of the children joined Staff 2 in the classroom.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580
VISIT DATE: 08/20/2024
NARRATIVE
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According to CCR 101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

Based on interview statements and observation, the facility is being cited in accordance with the California Code of Regulations, Title 22, Division 12, for the following section: 101229 Responsibility for Providing Care and Supervision.

LPA A. Silva informed licensee Director Suk Jung that this licensing report dated 8/20/2024 documents one “Type A” citation. Type A citations must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed the daycare representative that a copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care, a copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report, and signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the infant's file for verification of receipt of the report.

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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. A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with the daycare representative.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/20/2024 03:40 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 08/20/2024 at 03:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE LEARNING ACADEMY

FACILITY NUMBER: 304370580

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision ...(1) No child(ren) shall be left without the supervision ... Supervision shall include visual observation. This requirement was not met as evidenced by:
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I will make sure I double check the number of kids and double ckeck that they leave the room; make sure they are going to be in front of me. The licensee stated she would type the protocol and email it to the LPA.
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Based on observation and interview statements, the requirement was not met for one of ten children, which poses an immediate risk to the health, safety, and personal rights of children. C1 was left without supervision for around 5-10 minutes.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
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