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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270036
Report Date: 01/10/2024
Date Signed: 01/10/2024 02:54:03 PM

Document Has Been Signed on 01/10/2024 02:54 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:FULLERTON FREE PRESCHOOLFACILITY NUMBER:
304270036
ADMINISTRATOR:GUNTER, ANGELAFACILITY TYPE:
850
ADDRESS:2801 BREA BLVD.TELEPHONE:
(714) 529-5544
CITY:FULLERTONSTATE: CAZIP CODE:
92835
CAPACITY: 225TOTAL ENROLLED CHILDREN: 225CENSUS: 43DATE:
01/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Director Angela GunterTIME COMPLETED:
03:10 PM
NARRATIVE
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On 01/10/24 at 1:10pm, a case management inspection was conducted today by Licensing Program Analysts (LPAs) Anna Chan and Karen Navar who met with the Director, Angela Gunter. LPAs were led on a tour of the facility. There were 6 staff present and 43 children in care. A self-reported incident by the facility was received at the regional office on 11/17/23 which stated that child #1 (C1) was shocked by an electrical outlet and sustained electrical burns.

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.

Staff # 1 (S1) stated they did not see the incident. Staff #2 (S2) stated that while cleaning and wiping the lunch table, S2 stated that S2 had only visual supervision of the backs of the children facing the bookshelf. S2 stated S2 thought children were reading a book. S2 stated that S2 heard a popping sound and saw a spark where the children were sitting. S2 stated S2 saw Child 1 (C1) holding a long bobby pin. S2 also stated S2 ran to the sink and ran water over the injured fingers and called C1s parents. According to S2, C1 cried when the incident happened and stopped crying when parents arrived at the facility. When S2 asked C1 where C1 got the bobby pin, C1 pointed to the floor.

(Parent #1) P1 stated that C1 incurred electrical burns on two fingers and administered first aid at home. When P1 asked C1 what happened, C1 mentioned using the bobby pin to take out the cover of the socket. P1 stated C1 returned to school the next day.

Based on LPA’s observation on 11/22/23, the Caterpillar room’s (Rm 207) ground socket was covered with a metal plate and electric tape over it and a bookshelf partly covers the socket to make it inaccessible and to ensure safety and well-being of children in care.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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 4
Document Has Been Signed on 01/10/2024 02:54 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 01/10/2024 at 01:53 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: FULLERTON FREE PRESCHOOL
FACILITY NUMBER: 304270036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/11/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision 101229(a)(1): (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) …Supervision shall include visual observation. This requirement is not met as evidenced by:
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Director stated that electrical unit will be covered to make it inaccessible to children in care. A document stating the electical unit cannot be cut due to facility's electrical is connected. A document stating such will be sent to LPA on due date.
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Based on the interviews conducted, It was determined that C1 sustained electrical burns from an electrical outlet in caterpillar room 207 due to staff was not actively superving children's activity.
Which poses an immediate risk to the health and safety of the children in care.
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A photo of all ground sockets being covered in all five classroom in Bldg B will be sent to LPA on due date 1/11/24

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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:Judy Hanson
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024


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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FULLERTON FREE PRESCHOOL
FACILITY NUMBER: 304270036
VISIT DATE: 01/10/2024
NARRATIVE
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Based on LPA’s interviews and observation, The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following violations were cited today, 1 Type A for Responsibility for Providing Care and Supervision section 101229(a)(1) and 1 Type B for Buildings and Grounds section 101238(a)(1) was issued today on the attached LIC 809D. A Civil penalty assessed for repeat violation dated 11/22/23.

LPAs informed Director Angela Gunter that this report dated 01/10/24 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.

Also, LPAs informed Director Angela Gunter to provide a copy of this licensing report dated 01/10/24 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 Angela Gunter. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Appeal Rights and deficiencies 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.

End of Report
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 01/10/2024 02:54 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 01/10/2024 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: FULLERTON FREE PRESCHOOL
FACILITY NUMBER: 304270036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2024
Section Cited
CCR
101238(a)

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Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by:
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Director stated that a cleaning policy with the staff will be implemented daily. Staff are not allowed to wear bobby pins as a precaution.
A signed document stating those new procedure are being done will be sent to LPA by due date of 2/12/24
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Based the interviews conducted, It was determined that C1 sustained electrical burns from an electrical outlet in caterpillar rm207. C1 was able to open the metal plate using a bobby pin found on the floor.Which poses a potential 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.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024


LIC809 (FAS) - (06/04)
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