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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270647
Report Date: 09/16/2026
Date Signed: 09/16/2026 04:56:20 PM

Document Has Been Signed on 09/16/2026 04:56 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:FAMILY CAMPUS PRESCHOOLFACILITY NUMBER:
304270647
ADMINISTRATOR/
DIRECTOR:		NAVA, MARISSAFACILITY TYPE:
850
ADDRESS:10540 CHAPMAN AVENUETELEPHONE:
(714) 741-0970
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 50DATE:
09/16/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Nava, Marissa (Site Supervisor) and
Sarah Pham (Program Director)		TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 09/16/2026, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) V. Trinh in response to a self-reported incident dated 9/8/2026. LPA met with Sarah Pham (Program Director),and Marissa Nava (Site Supervisor), and was led on a tour. At the time of the inspection, 7 toddlers and two (2) staff members, and 43 preschool children and nine (9) staff members, were present. During the inspection, it was determined that the facility is operating within its licensed capacity and in compliance with staff-to-child ratios. Hours of operation are 7:00 AM-6:00 PM, Monday through Friday.

A review of the Facility Personnel Report Summary conducted on this date, 09/16/2026, indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the inspection on 9/16/26, the LPA interviewed the five (5) staff members involved in the incident. The LPA also reviewed the camera footage showing where C1 was left alone in the playground. Additionally, the LPA reviewed the Incident Report with the Program Director and Site Supervisor, along with the facility’s response.

During the interviews, all staff members stated they were aware Child #1 (C1) had been left alone on the playground during the transition from the playground to the classroom for approximately 4-5 minutes. Staff #5 (S5), witnessed C1 on the playground alone and brought C1 back inside the classroom. S5 notified the Site Supervisor and initiated an internal investigation.

According to the camera footage provided to Licensing, the LPA observed that C1 was left alone on the playground from approximately 10:32 a.m. through 10:36 a.m. on 9/8/2026

The facility was not in compliance with California Code of Regulations, Title 22, Division 12 & Chapter 1, 101229(a)(1) Responsibility for Providing Care and Supervision, and is being cited; see LIC 809-D.

Continued Page 2.

Nguyen K Tran
Vivian Trinh
DATE: 09/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2026
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: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647
VISIT DATE: 09/16/2026
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LPA Trinh informed Sarah Pham (Program Director),and Marissa Nava (Site Supervisor), , that this report dated 09/16/2026 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health and safety children in care.

LPA Trinh also informed the Sarah Pham (Program Director),and Marissa Nava (Site Supervisor), to provide a copy of this licensing report dated 09/16/2026, 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 Acknowledgment of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with Sarah Pham (Program Director) and Marissa Nava (Site Supervisor). The Notice of Site Visit was posted for no less than 30 consecutive days. Appeal Rights was explained.

End of the Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/16/2026 04:56 PM - It Cannot Be Edited


Created By: Vivian Trinh On 09/16/2026 at 03:30 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: FAMILY CAMPUS PRESCHOOL
FACILITY NUMBER: 304270647

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2026
Section Cited
CCR
101229(a)a(1)

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101229 (a)a(1) Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time. This requirement was not met as:
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The program director, and site supervisor stated they will conduct supervision training, go over playground rules, and ensure children are 100% supervised while in care. The director will provide the LPA with a sheet containing all staff signatures who attended the training by the POC due date via email.
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Based on observation (video), and interview, the facility did not comply with the section cited above. Staff left Child #1 (C1) in the playground for approximately 4-5 minutes. This poses an immediate health and safety risk to 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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2026


LIC809 (FAS) - (06/04)
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