304371187-7-31-2019-06-CC-JMHN-BELUZN-20190731160148

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371187
Report Date: 07/31/2019
Date Signed: 07/31/2019 04:01:54 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:	KOHITSUJI PRESCHOOL		FACILITY NUMBER:	304371187
ADMINISTRATOR:	SUZUKI, TAKAKO		FACILITY TYPE:	850
ADDRESS:	15 ORANGETREE		TELEPHONE:	(714) 717-5113
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY:	30	CENSUS: 10	DATE:	07/31/2019
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Takako Suzuki		TIME COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Plan of Correction inspection was conducted by Licensing Program Analyst (LPA) Jungmi Han in response to one A violation issued during an Inspection on 7/24/2019. During the inspection on 7/24/2019, the facility was issued one A violation for toddler component children were not physically separated from preschool children. This was immediate threat to the children's health and safety and were issued as A violation during the inspection on 7/24/2019. On 7/25/2019, the licensee Takako Suzuki submitted a correction for the violations. The licensee submitted a new toddler option registration form for toddler option children and updated Personnel Report that includes toddler option program teachers throughout a day. The facility has a preschool license with a toddler option. During today's Plan of Correction inspection, a census of children in care was taken and a physical plant inspection was conducted. LPA observed 3 children, one who is under two years old with 1 staff in room#102 and 7 preschool children with 1 staff in room#106 at 9:05AM. More children came to the facility at 9:05AM. LPA observed staff is moving children from #102 to toddler room. LPA observed 3 children, one who is under two years old with staff#2 in toddler option room at 9:08AM. 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. The facility was toured inside and outside. During the inspection it was observed that the facility is not operating within compliance of toddler option program regulations with California Code of Regulations, Title 22, Division 12, Section 101216.4(a)(2) . Civil penalty has been issued.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2019

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: KOHITSUJI PRESCHOOL	FACILITY NUMBER: 304371187
	VISIT DATE: 07/31/2019

NARRATIVE

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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.

Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00
If the facility receives a Type A violations, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days, and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2019

LIC809 (FAS) - (06/04)

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