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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371251
Report Date: 11/30/2023
Date Signed: 11/30/2023 10:41:20 AM


Document Has Been Signed on 11/30/2023 10:41 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCHFACILITY NUMBER:
304371251
ADMINISTRATOR:WELCH, AMBERFACILITY TYPE:
830
ADDRESS:20400 FAIRMONT CONNECTORTELEPHONE:
(714) 290-3993
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:19CENSUS: 6DATE:
11/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:WELCH, AMBERTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) A. Bootorabi conducted an unannounced visit for the purpose of a unusual self reported incident that occurred on 11/27/2023. LPA met with the director WELCH, AMBER upon arrival.

A review of the Facility Personnel Report Summary conducted on 11/30/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Census was 6 infants and 3 Staff in the infant room.

LPA interviewed 4 staff, reviewed 3 staff files, collected children's roster, staff roster, and incident report LIC624.

Due to insufficient information available currently, the above allegation needs further investigation. Further interviews and record reviews are required.

An exit interview was conducted, and the report was reviewed with the director, WELCH, AMBER. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
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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