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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310410
Report Date: 10/10/2025
Date Signed: 10/10/2025 11:32:52 AM

Document Has Been Signed on 10/10/2025 11:32 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LUPERCIO, GUADALUPEFACILITY NUMBER:
304310410
ADMINISTRATOR/
DIRECTOR:		LUPERCIO, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 604-8516
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Licensee, Guadalupe LuprecioTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Cynthia Sun conducted an unannounced follow-up case management inspection in response to a self-report Unusual Incident dated 09/15/2025. LPA met with Licensee, Guadalupe Lupercio and informed the purpose of today’s case management initiated on 09/24/2025. The census was taken as follows: 2 staff supervising, 8 preschool children.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal records and child abuse index clearances or exemptions.

On 9/15/2025, the Regional office received a self-reported Unusual Incident Report (UIR) from Licensee, Guadalupe Luprecio stating on Friday, 9/12/25 at 12pm Parent #1 (P1), advised licensee that child #1 (C1) did not want to come to the daycare because staff 2 (S2) hits C1. When P1asked C1how S2 hits C1, C1 couldn’t explain why. Then C1stated S2 hits C1 a little bit and then C1confessed that parent #2 (P2) P2 told C1 to say that S2 hits C1. S1 stated C1 parents have been separated, and they have 50/50 custody of C1. Per licensee, P1 stated that P2 has been trying to get full custody of C1 and P2 has been creating lies to try to obtain the full custody.

During the interview, P1 stated that C1 had no signs of bruises or marks. P1 also stated that C1 told P1 that P2 told C1 to say that C1 was getting hit at childcare. P1 stated that P1 and P2 have been separated for 3 years and P2 has been trying to get full custody of C1. Currently, P1and P2 have 50/50 custody of C1. P1 stated C1likes going to childcare. P1 also stated C1 has been attending same child care for close to 2 years and has only started complaining C1 doesn’t like childcare after C1 returns from being with P2.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2025
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: LUPERCIO, GUADALUPE
FACILITY NUMBER: 304310410
VISIT DATE: 10/10/2025
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On 09/24/2025, LPA interviewed Staff #1, (S1) who stated on Thursday 9/12/25, around 12:00 P1 spoke to S1 in person because C1 did not want to come to childcare and when P1 spoke to C1, C1 stated to P1 that S2 had hit C1. P1 told S1 that P1 knew C1 did not get hit here (at facility). P1 asked C1 to describe what happened and C1 told P1 that P2 had told C1 to say that S2 had hit C1. P1 stated that P2 is trying to take C1 from P1.

During the staff interview, 2 out of 2 staff stated when they discipline children they separate children, give children an alternate activity and then talk to child about behavior. 2 out of 2 staff stated they do not get physical/hit/grab or yell at childcare children. S1 stated S2 has a strong tone in voice but does not yell at children. S1 stated S2 will always communicate and update S1 if children arrive to facility with scratches or bruises.

LPA attempted to interview 5 children and was only able to interview 3 children. 3 out of 3 children interviewed stated no one yells at children in facility, no one makes children feel uncomfortable. 3 out of 3 children interviewed stated staff do not hit children.

LPA interviewed 5 facility parents and families did not disclose dissatisfaction with facility or commented concerns regarding UIR.

Based on LPA’s interviews and record review, there was no evidence to support the parent’s disclosure. The facility was in compliance with regulations, and no deficiency was observed.

Exit interview conducted and report was reviewed with Licensee Notice of Site Visit was posted and must remain posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2025
LIC809 (FAS) - (06/04)
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