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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370736
Report Date: 11/22/2019
Date Signed: 11/22/2019 11:41:29 AM

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:FUN 4 KIDS PRESCHOOLFACILITY NUMBER:
304370736
ADMINISTRATOR:MANSPERGER, ASHLEYFACILITY TYPE:
840
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY:30CENSUS: 0DATE:
11/22/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Asley ManspergerTIME COMPLETED:
11:20 AM
NARRATIVE
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A Plan of Correction inspection was conducted by Licensing Program Analyst (LPA) Jungmi Han in response to six Type B violations issued during an Inspection on 8/13/2019. During the inspection on 8/13/2019, the facility was issued six Type B violations for school age component: the facility kept expired prescription/non-prescription medications in medication box, parents did not sign in and out children with full legal signatures and/or time, Mandated reporter training certificates for staff#2 and staff#5, outdoor activity area did not have drinking water for children, personal right form was not posted, Immunization records for staff#2 and staff#5. These were potential Health, Safety, and Personal rights risk to children in care and were issued as Type B violations during the inspection on 8/13/2019. On 11/22/2019, LPA Han inspected and observed the facility corrected the violations except mandated reporter training certificate and Immunization records for staff#2. Director was told to submit mandated reporter training certificate and Immunization records for staff#2 by end of 11/22/2019.
During today's Plan of Correction inspection, a census of children in care was taken and a physical plant inspection was conducted. LPA observed 0 school age children with 0 staff members.

In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal Rights and deficiencies were discussed. The director was provided a copy of their 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 Licensing office within 15 business days. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov 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.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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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