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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311650
Report Date: 06/12/2024
Date Signed: 06/19/2024 01:15:37 PM

Document Has Been Signed on 06/19/2024 01:15 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:PEREZ, ANGELLUZFACILITY NUMBER:
304311650
ADMINISTRATOR/
DIRECTOR:		PEREZ, ANGELLUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 614-1709
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/12/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Licensee, Angelluz PerezTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Cynthia Sun. At 2:45 PM. LPA observed licensee and assistant Aurora Piedra caring for 7 children which included 4 infants, 2 preschool and 1school age children waking up from nap and playing quiet games. Licensee was operating within the licensed capacity as specified on license.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 4 adults including the licensee and 2 minor child living in the facility. Facility Day care hours are 6 AM-6 PM, Monday through Friday.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of child safety gates. The childcare area consists of the family room, 1 bathroom next to family room and gated backyard which is accessed through a side gate of the backyard. Licensee stated the children's primary childcare areas are the family room and backyard. There is a combination working carbon monoxide and smoke detector in the family room (childcare area), and fire extinguisher in the home next to kitchen that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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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: PEREZ, ANGELLUZ
FACILITY NUMBER: 304311650
VISIT DATE: 06/12/2024
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Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during area to children in care. The home has age-appropriate toys for the ages served. During today’s inspection LPA observed a box with small beads and string for older school age children, licensee removed box with small beads and string and made inaccessible to infants and preschool children. Licensee stated, school age child uses beads with string while infants and preschoolers are napping.

. LPA verified there is a working telephone service (cellular service), licensee was reminded that childcare phone needs to remain the in the childcare at all times. Licensee stated they use the backyard for outdoor play. There are no bodies of water on the premises.

The licensee does has a current roster of children in care Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700), Immunization records, Affidavit Regarding Liability Insurance (LIC282), Consent for Emergency Medical Treatment (LIC627), Notification of Parent’s Rights (LIC995A) and found to be in compliance. Licensee stated, there are 4 infants under 24 months enrolled in the childcare.



END OF REPORT
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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