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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270907
Report Date: 01/08/2024
Date Signed: 01/08/2024 02:54:13 PM


Document Has Been Signed on 01/08/2024 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:HILLSBOROUGH PRIVATE SCHOOLFACILITY NUMBER:
304270907
ADMINISTRATOR:POWERS, LAURENFACILITY TYPE:
850
ADDRESS:4757 VALLEY VIEWTELEPHONE:
(714) 572-5696
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:97CENSUS: 27DATE:
01/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Director Amy HalitTIME COMPLETED:
03:15 PM
NARRATIVE
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On 01/08/24 Licensing Program Analyst (LPA) Anna Chan conducted a case management deficiency report. LPA met with Director Amy Halit and informed the Director of the purpose of the visit. During today's visit, a tour of the facility was conducted. The overall census observed was 27 preschool children and 3 staff. Children were napping when LPA arrived.

During a complaint investigation on 10/24/23, it was discovered that there is a new director in the facility. There are no records of the facility contacting Community Care Licensing Department reporting the change. During interview, representative representative stated that they did not inform licensing about replacing the director since September.

Based on record review and interview, the following deficiency was discussed and cited. The facility was not in compliance with the California Code of Regulations, Title 22, Division 12, Section 102416.2(b) Reporting Requirements. Please refer to LIC809D for details of deficiency.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Director, Amy Halit was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

End of Report

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca ChanTELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024
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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Document Has Been Signed on 01/08/2024 02:54 PM - It Cannot Be Edited

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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304270907

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/08/2024
Section Cited
CCR
102416.2(b)

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Reporting Requiremets
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
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Director's packet will be sent to LPA by due date of 2/8/24 via email
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This requirement is not met as evidenced by:

Based on interview and record review, the facility did not report to licensing office about the change of director in September.
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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 HansonTELEPHONE: (714) 703-2822
LICENSING EVALUATOR NAME: Anna Francesca ChanTELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024
LIC809 (FAS) - (06/04)
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