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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312843
Report Date: 05/22/2024
Date Signed: 05/22/2024 05:33:04 PM

Document Has Been Signed on 05/22/2024 05:33 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEE, RAISSAFACILITY NUMBER:
304312843
ADMINISTRATOR/
DIRECTOR:
LEE, RAISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 387-6197
CITY:IRVINESTATE: CAZIP CODE:
92614
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
05/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Licensee, Raissa Lee TIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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Licensing Program Analysts (LPAs) Valdez Santana and Castro conducted an on-site inspection for the purpose of a Case Management Incident Inspection on 5/22/2024 LPAs toured the facility. Census was taken, there were 6 preschool-age children present supervised by licensee. Today's Case Management inspection is being conducted in response to a self-reported incident, reported to the OC CCL office on 05/21/24, detailing child #1 (C1), had wandered away from the licensee during an outside walk. It was reported that the facility staff may have lacked supervision allowing the child to wander away from licensee.

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.

During today's visit, LPA obtained a Children’s Roster, copy of Daily Schedule, copy of Children’s Admission Agreement and reviewed 5 children’s files and one staff file. LPA also received emails that included: pictures and screen shot of camera footage of the day of the incident. At this time further investigation is needed. Exit interview was conducted with facility representative and notice of site visit posted at entrance of facility. Notice of site visit is to remain posted for no less than 30 days.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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