<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371251
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:28:52 PM

Document Has Been Signed on 01/18/2024 02:28 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
ORANGE COUNTY CC RO, 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: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 8DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Director Amber WelchTIME COMPLETED:
02:50 PM
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
On 01/18/24 at 11:15am, A case management inspection was conducted today by Licensing Program Analyst (LPA) Anna Chan who met with Director Amber Welch. Director was informed for the reason of visit. This is a continuation investigation of a self-reported incident by the facility that was received at the regional office on 11/27/23, which stated that child sustained burns from water from bottle warmer.

Upon arrival there were 3 staff present and 8 infants. A review of criminal record clearances 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 this investigation, LPA interviewed 8 staff, took photos of child’s burnt area, and obtained a copy of the children’s roster. Director will email a copy of Personal Summary Report and signed and documented training that was done after the incident.

A consultation was given to the director regarding sleep sack waiver. LPA Reviewed Individual Infant Sleep Plan and Needs and services plan for 2 infants. A consultation about Changing table and food preparation area was done.

LPA obtained POC documentation for missing mandated reporter training certificate for 2 staff from previous visit on 11/30/23.

Due to insufficient information available at this time, further investigation is needed. If any deficiencies are observed, disclosed or discovered during today’s visit, they will be addressed and cited at a later date.



Exit interview was conducted with Director Amber Welch. The Notice of Site Visit was posted. Facility 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.

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

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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 1