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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371253
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:43:49 PM


Document Has Been Signed on 04/11/2024 02:43 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:APPLE TREE PRESCHOOL & KINDERGARTENFACILITY NUMBER:
304371253
ADMINISTRATOR:PERANCULLO, MARBENFACILITY TYPE:
830
ADDRESS:2211 WEST WOODLEY AVENUETELEPHONE:
(714) 772-1005
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:30CENSUS: 27DATE:
04/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Ishara Silva (Director)TIME COMPLETED:
02:45 PM
NARRATIVE
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On 4/11/2024, Licensing Program Analysts (LPA) A. Silva conducted a Case Management – Deficiencies due to deficiencies observed during a visit. Upon arrival, the LPAs meet with Ishara Silva. An on-site Facility Personnel Report Summary review indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Census was 9 infants and 18 toddlers at the time of visit. The facility was operating within ratios and capacity.

Per CCR 101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. The LPA observed six infants sleeping in cribs with blankets.

Based on observation, the facility is being cited in accordance with the California Code of Regulations, Title 22, Division 12, for the following section: 101439.1(f) Infant Care Center Sleeping Equipment.

LPA A. Silva informed licensee Director Ishara Silva that this licensing report dated 4/11/2024 documents one “Type A” citation(s). Type A citation(s) must be posted for 30 consecutive days during the hours that children are in care as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA A. Silva further informed Director Silva that a copy of this licensing report must be provided to parents or guardians of all clients currently enrolled by the next business day or by the next day the children are in care, a copy of this report must be provided to the parents or guardians of all newly enrolled clients for 12 months from the date of this report, and signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form, or another written equivalent statement, must be placed in the infant's file for verification of receipt of the report.

CONTINUE ON NEXT PAGE.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 304371253
VISIT DATE: 04/11/2024
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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. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with director Ruby Porter.

end.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2024 02:43 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: APPLE TREE PRESCHOOL & KINDERGARTEN
FACILITY NUMBER: 304371253

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/12/2024
Section Cited
CCR
101439.1(f)

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101439.1(f) Infant Care Center Sleeping Equipment. Cribs shall be free from all loose articles and objects, including blankets and pillows.
The licensee did not meet the regulation above as evidenced by:
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The Director stated a training about infant safe sleep regulations will be held. The director will send the materials and a sing in sheet for participating staff to the LPA by the due date.
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Based on observation, the licensee did not meet the regulation above in 6 out of 6 cribs. The LPA observeed 5 infants sleeping in cribs that contained loose articles.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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