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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270776
Report Date: 08/20/2026
Date Signed: 08/20/2026 03:14:22 PM

Document Has Been Signed on 08/20/2026 03:14 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:ANAHEIM ELEMENTARY SCHOOL DISTRICT MADISONFACILITY NUMBER:
304270776
ADMINISTRATOR/
DIRECTOR:		KAUR, APINDERFACILITY TYPE:
850
ADDRESS:1510 SOUTH NUTWOOD STREETTELEPHONE:
(714) 517-8935
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY: 22TOTAL ENROLLED CHILDREN: 10CENSUS: 9DATE:
08/20/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:16 PM
MET WITH:Lead Teacher, Apinder KaurTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Dianna Valdez Santana conducted an on-site visit for the purpose of a Case Management Incident Inspection on 08/20/2026. LPA toured the facility. Census was taken, there were 9 preschool age-children present supervised by 3 staff and 1 volunteer. Today's Case Management inspection is being conducted in response to a self-reported incident, reported to the Orange County Community Care Licensing office on 08/11/2026, regarding an incident detailing Child #1 (C1) eloped from the facility. Facility representative stated there are 11 children enrolled in the AM session and 10 children enrolled in the PM session.

A review of the Facility Personnel Report Summary conducted on today’s date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Facility reported the incident within 24 hours and is found to be in compliance with Title 22 Division 12 reporting requirements.

During today's inspection LPA Valdez Santana interviewed 2 staff members. LPA did not interview child due to the child having a difficult time still adjusting to the school and was refusing to talk.

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Tina Nguyen
Dianna ValdezSantana
DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2026
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: ANAHEIM ELEMENTARY SCHOOL DISTRICT MADISON
FACILITY NUMBER: 304270776
VISIT DATE: 08/20/2026
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During today's staff interviews, 2 out of 2 staff stated that immediately after C1 started running, Staff #1 (S1) ran after C1. S1 stated it was C1’s second day of school and was struggling to adjust. C1 was crying and upset since arriving to the facility. S1 stated being with C1, about 5 minutes at approximately 12:10pm after C1’s parent left, the child ran in same direction. S1 stated typically there is a chain on the smaller gate (1st gate) but it had been removed, there is also a lower latch on the parent entry gate (2nd gate) but since C1’s parent left late all the staff were on the other side of the gate with the children so the lower latch wasn’t lowered after the parent left making it accessible for C1 to pass through both gates. S1 caught up to C1 as C1 was crossing the street and was able to return C1 to the facility. Staff stated since the incident, they have added a top latch to both gates ensuring inaccessibility for children. Staff #2 (S2) stated seeing S1 run right after C1 and saw that S1 caught up with C1. S2 stated it was about a 1 minute when C1 was running. S2 stated normally the latch on the bottom is down ensuring children cannot get through and there used to be a chain on the other gate. Now there are additional latches on the gates that are high so that children cannot access them.

LPA thoroughly inspected the facility and observed the distance the child traveled, and it was approximately 115 feet. LPA observed the new latches on the gates that are placed high out of children’s reach. Additionally, the staff stated they are no longer allowing parents and children that arrive late to enter their gate, they must now enter through the main office to ensure once the latches on the parent entry gate remain locked except during transition times.

Based on LPA observations, interviews which were conducted, and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies cited during today's inspection.

Exit interview was conducted. The Notice of Site Visit was posted for no less than 30 consecutive days. Appeal Rights were provided and explained and their signatures on this form acknowledges receipt of these rights.



Page 2 of 2. End of Report
NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Dianna ValdezSantana
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC809 (FAS) - (06/04)
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