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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614039
Report Date: 06/19/2024
Date Signed: 06/19/2024 02:56:16 PM

Document Has Been Signed on 06/19/2024 02:56 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:ABC DEVELOPMENT PRESCHOOL #3FACILITY NUMBER:
300614039
ADMINISTRATOR/
DIRECTOR:		CALVILLO, LISAFACILITY TYPE:
840
ADDRESS:9972 GRAHAM STTELEPHONE:
(714) 821-4222
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 0DATE:
06/19/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Kelly Santos, Operations DirectorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) P Rivas conducted an office Meeting with Kelly Santos , Operations Director to review the lic 200a and facility sketch as application was received 04/18/24 but have had discrepancies in room numbers and sketches. A letter was sent May 23, 2024 advising of information needed.
During today's visit, LPA received an updated lic 200a and facility sketch that requests a capacity increase in the school age licence to 258 children ages 12 years old M-F 1:00pm-6:00pm Rms MPR, 13, 14, 43, 44 and DC1 from 1 to 6pm -LPA was advised that during summer licensee is allowed to use entire premises.

There will be no change to the pre school license, which is currently licensed for rooms DC1, DC2 and DC3. Rooms had been renamed by school district . B2 is the MPR room, DC1 was previously room C3.

LPA reviewed application information and found the following to be incomplete or incorrect;
1. Current lease agreement
2. LIc 500 that meets ratios for requested capacity and show current correct job titles. Can indicate position as To Be Hired.
3. A statement that there is no changes to employee policies, incidental medical services plan- statement have one and no change since licensed.
4. An Updated Lic 610 .
5. Schedules for both programs
6. Front page from parent handbook.

A fire clearance request will be sent.


Items to be sent to LPA Rivas by July 19, 2024. A pre licensing visit will be conducted after a fire clearance has been received.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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