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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371251
Report Date: 04/09/2021
Date Signed: 04/09/2021 01:19:27 PM

Document Has Been Signed on 04/09/2021 01:19 PM - 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:CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCHFACILITY NUMBER:
304371251
ADMINISTRATOR:RICE, SHARLENEFACILITY TYPE:
830
ADDRESS:20400 FAIRMONT CONNECTORTELEPHONE:
(714) 290-3993
CITY:YORBA LINDASTATE: CAZIP CODE:
92866
CAPACITY: 30TOTAL ENROLLED CHILDREN: 19CENSUS: 10DATE:
04/09/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Ms. Rice SharleneTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Case Management Licensee initiated inspection for a change in capacity. Licensee is requesting a change to the current Infant capacity from 30 infants to 19 infants age (6 weeks to 24 months). The Licensee is Decreasing the capacity by removing one classroom (Room # 102 also identified as a yellow room.

LPA met with Facility Administrator Ms. Rice, Sharlene, who gave a tour of the Preschool classrooms.

All areas identified on the Facility Sketch were inspected. Furniture and equipment were inspected for age appropriateness and good repair in the infant rooms. Napping area has appropriate cribs for younger infants and cots for older infants. There is changing station placed at arm’s length. Age appropriate sinks and Potty chairs were inspected for availability, good repair, water temperature, toilet paper, paper towels, area safety and sanitation. First Aid supplies were inventoried. Playground is completely enclosed by a fence. Outdoor activity area is supplied with age and size appropriate equipment including a climbing structure. An adequate amount of cushioning material is in place under the equipment. Shade is provided by awnings and a Water pitcher and personnel water bottles are used for drinking water. A review of medication policy, including administering, labeling, storage, and records were made, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting, and criminal records clearances/exemption transfer requests.


The crib area in Room # 100 (Nursery) is separated from the activity area by wooden gate. (The crib area/napping area is not calculated in the measurement). There is a sink in the crib area close to changing area.

Facility shall use the following two rooms for the Infant component.

Room # 100 (Nursery): 20 x 18’92 = 378’40
Room # 103 (Green): 23’75 x 14’75 = 376’14 – 82’19 = 293’95
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2021
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: CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCH
FACILITY NUMBER: 304371251
VISIT DATE: 04/09/2021
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Total Indoor capacity: 672’35 / 35 = 19’21 (19 Infants)

Outdoor Activity Space (previously measured on 04/10/2019): The Infant playground is approximately 2425 square feet divided by 75 is approximately 32 children. Playground area is completely fenced off.



Based on today's inspection facility has enough space for the requested capacity of 19 Infants (6 weeks to 24 months). Monday to Friday 7.00 am to 6.00 PM in the two designated rooms for Infant component (Room # 100 (Nursery) and Room # 103 (Green room).

Administrator Ms. Rice, Sharlene is current on the required CPR and First aid training (3/23) including the Preventative Health and Safety Nutrition and Lead Poisoning training and facility has completed the new Water testing requirement.

License shall be granted after the final approval by the management.

Report was read to the Facility Administrator and appeal rights were provided.

Notice of site visit posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021
LIC809 (FAS) - (06/04)
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