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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371075
Report Date: 02/20/2020
Date Signed: 02/20/2020 02:11:49 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:FAIRMONT PRIVATE SCHOOLFACILITY NUMBER:
304371075
ADMINISTRATOR:MARTINEZ, MONICAFACILITY TYPE:
850
ADDRESS:1557 WEST MABLE STREETTELEPHONE:
(714) 563-4050
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY:42CENSUS: 26DATE:
02/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Mr. Calabria-Campus DirectorTIME COMPLETED:
02:30 PM
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The purpose of this inspection was to conduct a Case Management due to the facility self reporting an alleged incident which occurred at the facility on 2/12/20. LPA met with Mr. Calabria who is the Campus Director due to the director, Rebecca Lugo, is not present at the facility today.
Census was taken in individual classrooms. The overall census observed was 5 preschool staff and preschool children. 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.

During today's inspection Licensing Program Analyst (LPA) Taylor obtained a current children's roster.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) 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.

The facility representative 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. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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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