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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370736
Report Date: 08/13/2019
Date Signed: 08/15/2019 05:03:20 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: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: 13DATE:
08/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Emily Yoon - AdministratorTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Han conducted an unannounced annual/random inspection of the facility on today's date. LPA Han toured the facility with the administrator, Emily Yoon inside and outside. Census was taken in individual classrooms. The overall census observed was 2 school-age staff and 13 school-age children. Children were playing outdoor area. 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. Operating hours are 6:00 am- 6:30 pm, Mon-Fri.

The items which could pose a danger to children such as detergents, cleaning compounds, and medications were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. LPA observed expired medications with staff#4. Staff#4 removed all expired medications immediately. Food is prepared on site; lunch and snacks are provided. Food prep areas appear clean and sanitary. Food is properly stored. On site kitchen is free from hazards. The toys, floors, desks and other equipment appeared clean.

There is drinking water available to children indoors. LPA observed there is non-working water fountains nor readily available water pitcher with individual cups for children. LPA interviewed staff#1 and staff#3 about outdoor water for children. Both staff stated they uses big water cooler while children are playing at outdoor area. Staff#1 stated she doesn’t know why it is not out at the outdoor space.

The children's bathrooms are clean and sanitary. School age children are not taking nap at the facility. The facility has conducted an emergency drill within the past six months. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher. The playground was completely fenced. The playground equipment appeared in safe condition. There is insufficient cushioning underneath swing structure to absorb falls. Sign in/out procedure was reviewed. LPA observed several missing signatures and sign in and out times.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
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 7
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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(a)(1)
Sign in and out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
Deficient Practice Statement
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Based on record review, director failed to ensure to maintain full legal signature and record time for in/out for children. This poses a potential Safety risk to the children in care.
POC Due Date: 08/27/2019
Plan of Correction
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Site supervisor will send out reminder letter to families. Administrator will review sign in and out sheet daily and follow up with parents on the next day. Site supervisor will send reminder letter to LPA by email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Reporting Requirements - Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

Deficient Practice Statement
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Based on record review, director failed to ensure to maintain two staff mandated reporter training certificates in the staff file. This poses a potential Safety risk to the children in care.
POC Due Date: 08/27/2019
Plan of Correction
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Site supervisor will submit two staff mandated reporter training certificates by emil by due date.
Section Cited
Deficient Practice Statement
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POC Due Date: 08/21/2019
Plan of Correction
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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 MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370736
VISIT DATE: 08/13/2019
NARRATIVE
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At 9:40AM, LPA Han met staff#4, Site Supervisor. Staff#4 stated current director had car accident at the end of April. Staff#4 stated she called licensing office on 5/21/2019 and report change of director. LPA Han did not receive any phone call, email, nor a new director’s packet regarding temporary director. Per staff#4, director will resume to work as director on 8/19/2019. LPA observed required Personal Right form (LIC 613A) is not posted in a prominent, publicly accessible area in the center. Staff#4 posted during the inspection. During today's visit staffing ratios were being met. At least one staff member present possesses current CPR/First Aid certifications, which expires 8/2019. Children's and staff files were reviewed for compliance.

The facility currently does not provide Incident Medical Services.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on LPAs observations, record reviews, and interviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101238.2(e), 101239(f)(1), 101239.2(a), 101226(e) (6), 101223(b)(2), 101229.1(a)(1) and Health and Safety 1596.7995(a)(1), 1596.8662(b)(1). Please refer to attached 809D for documentation of deficiencies.

Proof of immunizations against pertussis and measles for all employees/volunteers were reviewed for compliance with SB 792. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.
A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(6)
Care and Supervision
(6) When no longer needed by the child, or when the child withdraws from the center, all medications shall be returned to the child's authorized representative or disposed of after an attempt to reach the authorized representative.
Deficient Practice Statement
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Based on observation and interview, diretor failed to returned or disposed of expired prescription/non-prescription medications to the child's authorized representative. This poses a potential Safety risk to the children in care.
POC Due Date: 08/27/2019
Plan of Correction
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Site supervisor removed all expired prescription/non-prescription medications from medication box during the inspection. Site supervisorstated she conduct the training with closing staff. Site supervisor will submit training plan statement and closing staff names by email.
Type B
Section Cited
CCR
101223(b)(2)
Physical Plant
(2) The center shall post a copy of the LIC 613A (9/96) in a prominent, publicly accessible area in the center.
Deficient Practice Statement
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Based on observation and interview, director failed to post personal right form (LIC 613A) in a prominent, publicly accessible area in the center. This poses a potential Safety risk to the children in care.
POC Due Date: 08/13/2019
Plan of Correction
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Site supervisor posted during the inspection.
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 MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370736
VISIT DATE: 08/13/2019
NARRATIVE
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Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
Always place infants on their backs for sleeping
Use only a tight-fitting sheet on the crib or play yard mattress
Do not hang any items from the crib or above the crib
Keep all items, including blankets, out of the crib or play yard
Pacifiers may be used as long as they do not have items attached to them
Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org
The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)
- Daily Activity Schedule

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: 08/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370736
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.2(a)
Physical Plant - Drinking Water
(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

Deficient Practice Statement
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Based on observation and interview, director failed to ensure to provide outdoor dringking water for children early in the morning. This poses a potential Safety risk to the children in care.
POC Due Date: 08/27/2019
Plan of Correction
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Site supervisor stated she will retrain openning duty staff. Site supervisor will submit training statement by email by due datre.
Type B
Section Cited
HSC
1596.7995(a)(1)
Staff Records - California Child Day Care Act
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Deficient Practice Statement
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Based on record review and interview, director failed to ensure to maintain two staff's immunization record in staff file.
POC Due Date: 08/27/2019
Plan of Correction
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Site supervisor contacted two staff for immunization records. Site supervisor will submit proof by email.
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 MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi HanTELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2019
LIC809 (FAS) - (06/04)
Page: 7 of 7