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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605329
Report Date: 05/01/2025
Date Signed: 05/01/2025 02:59:33 PM

Document Has Been Signed on 05/01/2025 02:59 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:OUSD-CHILD DEVELOPMENT CENTER PRESCHOOLFACILITY NUMBER:
300605329
ADMINISTRATOR/
DIRECTOR:		YBARRA, RENEEFACILITY TYPE:
850
ADDRESS:250 SOUTH YORBATELEPHONE:
(714) 628-5570
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 19DATE:
05/01/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Director Renee YbarraTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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On 05/01/25, at 12:00pm, a case management inspection was conducted by Licensing Program Analyst (LPA), Anna Chan who met with Director, Renee Ybarra. LPA was lead on a walkthrough of the facility. A self-reported incident by the facility was received at the Regional Office which stated that Child #1 (C1) was left alone in the classroom unsupervised. Census was taken. Census was 19 preschool children and 4 staff.

Based on a self-reported incident, on 04/21/25, facility staff found C1 who was left alone in Classroom T. Based on staff interviews, at around 10am, Staff 2 (S2) stated the class was transitioning from restroom, to setting up their beds and lining up by the door before going outside. S2 stated S2 was aware there were 3 children left in the classroom with Staff 1 (S1) before going to the playground. S2 stated S2 could not recall if the number of children was communicated to S1 before going out. S1 stated that S1 was in classroom T waiting for children to finish setting up their beds. S1 stated they left the classroom with only 2 children and went to the playground with the rest of the class. S1 stated S1 was not aware there were 3 children. S1 and S2 stated a headcount was not conducted at this time. S1 and S2 stated they saw another staff walking with C1 before they realized that C1 was left in the classroom unsupervised. Staff stated C1 was left unsupervised inside the classroom for approximately 10 minutes. Classroom T is located by the entrance gate of the facility and is about 100 feet away from the playground.

Based on the information gathered from the interviews conducted, it was determined that C1 was left in the T classroom unsupervised.

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NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Anna Francesca Chan
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUSD-CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 300605329
VISIT DATE: 05/01/2025
NARRATIVE
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On 5/1/25, LPA attempted to interview C1, C1 was only nodding to questions and not verbally responsive at this time.

The facility stated the child's authorized representative was notified of the incident immediately.

Since the incident, director stated they have adjusted to a new procedure to ensure supervision to children. Director stated the staff was reminded of the supervision guideline and a CDSS video was sent to watch as a refresher on supervision.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. 1 Type A violation cited for section 101229(a)(1) Responsibility for Providing Care and Supervision.

LPA Chan informed Director Renee Ybarra that this report dated 05/01/25 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPA Chan also informed the Director Renee Ybarra, to provide a copy of this licensing report dated 05/01/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Renee Ybarra. Deficiency was discussed Appeal Rights was provided. A notice of site visit was given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Anna Francesca Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/01/2025 02:59 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 05/01/2025 at 01:57 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: OUSD-CHILD DEVELOPMENT CENTER PRESCHOOL
FACILITY NUMBER: 300605329

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision 101229(a)(1): No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified...
This requirement is not met as evidenced by:

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Director stated a training was conducted with the staff and a new procedure was implemented to ensure supervision. Proof of documentation of the training and procedure signed by all staff will be sent to LPA by due date on 5/2/25
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Based on staff interviews, staff stated C1 was left alone and unsupervised in the Classroom T.

This is an immediate risk to the health and safety of the children in care.
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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.
Martha Malane
NAME OF LICENSING PROGRAM MANAGER:
Anna Francesca Chan
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2025


LIC809 (FAS) - (06/04)
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