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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370736
Report Date: 09/08/2023
Date Signed: 09/08/2023 10:25:17 AM


Document Has Been Signed on 09/08/2023 10:25 AM - It Cannot Be Edited

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:WOJCIK, MELISSAFACILITY TYPE:
840
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY:30CENSUS: 0DATE:
09/08/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Melissa WojcikTIME COMPLETED:
10:30 AM
NARRATIVE
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In conjunction with another inspection at the facility, Licensing Program Analyst (LPA) Dianna Valdez Santana conducted a case management inspection.

LPA was met by Director, Melissa Wojcik who provided a tour of the facility. LPA observed 0 school-age children in care at the time of the inspection.

A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.


Through staff interviews Staff 3 (S3) disclosed that when S3 has been over ratio by at least 1, S3 sends school-age children to the preschool rooms. Staff #8 (S8) said, sometimes yes in morning, there is comingling from 6am- 7am. Child #1 (C1) stated, All the time there are 3 and 4 yr. olds are with us, in the afternoon sometimes in the classroom and sometimes outside. Child #2 (C2) said there are 3- and 4-year-old kids in the classroom. Child #4 (C4) disclosed, Yes, sometimes there are preschool kids in C4’s school-age classroom. C4 said it is C5 from preschool that comes into their class at around 3pm. LPA gathered sign in/out sheets and staff timecards for 06/12/23, records indicate from 6am-7am, there was 1 infant, 2 preschoolers and 1 school-age child with one staff. Facility has a comingle waiver from 6am-7am but only for preschool and school-age it does not include infants.

Based on the gathered information, the facility is in violation and being cited for one Type B Limitations on Capacity CCR Section 101161(a). This is a potential health and safety and personal rights risk to the children in care. See deficiency observed and cited on LIC 809D.



Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report. End of Report.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Dianna ValdezSantanaTELEPHONE: 714-292-8628
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023
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 2


Document Has Been Signed on 09/08/2023 10:25 AM - It Cannot Be Edited

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: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2023
Section Cited
CCR
101161(a)

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Limitations on Capacity: (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement was not met as evidenced by:
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Director stated she hired 2 new staff and staggered the aides' schedule to meet the ratio needs. Director said she will have staff meeting today to address comingling and other urgent topics. Diirector will email LPA meeting agenda and staff sign in.
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Staff #3 stated, when over by one, S3 sends school-age child with preschool. Staff 8 there is comingling between, infants, preschool and school-age during 6am-7am. Child #4 stated there is at least one preschool child put often .into the school-age classroom at 3pm
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Director wilDirector she will email LPA at dianna.valdezsantana@dss,ca.gov by POC due date.

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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: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Dianna ValdezSantanaTELEPHONE: 714-292-8628
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2