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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304206440
Report Date: 12/15/2021
Date Signed: 12/15/2021 11:44:42 AM

Document Has Been Signed on 12/15/2021 11:44 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:AGUILAR, NORA B.FACILITY NUMBER:
304206440
ADMINISTRATOR:AGUILAR, NORA B.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 839-5703
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 4DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nora Aguilar, LicenseeTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Alanna Gontarek conducted an unannounced case management- incident inspection and met with Licensee, Nora Aguilar, who guided LPA on a tour of the facility. The purpose of the visit was to discuss the Unusual Incident that occurred on 11/18/2021.

In regards to the Unusual Incident dated 11/18/2021, Licensee, Nora Aguilar, reported: Child #1 (C1)'s mother called licensee to inform her that (C2) threatened (C1) stating, "give me 50 bucks if not I'm going to rip your head off." LPA went over the Incident Report with Licensee, Nora Aguilar.

LPA observed 3 preschool children and 1 infant in care on this date, upon arrival. LPA interviewed Licensee and (C1)'s authorized representative, and reviewed and received children's roster.

Based on information obtained on this date, including interviews conducted, and a letter from (C1)'s authorized representative, it was found that the incident between (C1) and (C2) occurred outside of the facility. No follow up is necessary regarding the incident report listed above.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1 in regards to the above mentioned Unusual Incident Report.

A Confidential Names list (LIC811) was provided during this visit.

Exit interview conducted with Licensee Nora Aguilar. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of the report (LIC 809). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Alanna Gontarek
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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