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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370702
Report Date: 08/28/2019
Date Signed: 08/28/2019 03:27:01 PM

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:SUNFLOWER PRESCHOOL & KINDERGARTENFACILITY NUMBER:
304370702
ADMINISTRATOR:GARDUNO, MICHELLEFACILITY TYPE:
850
ADDRESS:2129 W EDINGERTELEPHONE:
(714) 979-7422
CITY:SANTA ANASTATE: CAZIP CODE:
92704
CAPACITY:59CENSUS: 46DATE:
08/28/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:44 PM
MET WITH:Director Michelle GardunoTIME COMPLETED:
03:50 PM
NARRATIVE
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An unannounced Case Management inspection is being conducted on this date by Licensing Program Analyst (LPA), Barajas, due to deficiencies found during inspection.

During today's inspection there were 8 preschoolers with 1 staff Vanessa Walker, 10 preschoolers in a different classroom with 1 Staff Claudia Valencia, 11 children in 3 year old classroom with 1 staff Jazmin Garcia in another classroom and 17 children in 4 year old classroom with 2 Staff Jazmin Ortiz and Stacy Acosta.

Based on LPA Barajas observation during record review of behavior reports and interview with a Staff, it was determined an unusual incident occurred on 08/26/19 around 4:10p.m. and was not reported to Licensing Department within 24 hours and a written Unusual Incident Report LIC 624 had not been filled out and submitted. LPA Barajas reminded Staff, has 7 business days to mail, drop off, fax or email copy of LIC 624 to Licensing Department from date of incident. Facility is being cited for Reporting Requirements Code of Regulations, Title 22, Section 101212(d)(1)(C)

Exit interview was conducted with Director Michelle Garduno. Notice of Site Visit was posted during the visit. 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. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019
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: SUNFLOWER PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 304370702
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited

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Reporting Requirements101212(d)(1)(C ): (d)Upon the occurrence, during the operation... (d)(1) below, a report shall be made to the Dept by telephone… within the Department's next working day and during its normal business hours. In addition, a written report containing the information…within seven days following occurrence… (1)Events reported shall include the following:…(C)Any... that threatens... This requirement was not met as evidenced by:
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Based on record review of behavior reports and interview with a Staff, it was determined an unusual incident occurred on 08/26/19 around 4:10p.m. and was not reported to Licensing Department within 24 hours.This poses a potential immediate threat to the health and safety of children in care.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor BarajasTELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2019
LIC809 (FAS) - (06/04)
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