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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313745
Report Date: 08/23/2023
Date Signed: 08/23/2023 02:05:41 PM

Document Has Been Signed on 08/23/2023 02:05 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SELIAN, HITOMIFACILITY NUMBER:
304313745
ADMINISTRATOR:SELIAN, HITOMIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-2517
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Licensee, Hitomi Selian TIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Aiddee Nunez conducted a case management visit initiated by Licensee.
Hitomi Selian had requested to add the dining room which is an off limit area to the facility floor plan.

Upon arrival LPA no children were present only Licensee’s child was in the home. Licensee was not providing care due to doctor’s appointment. The home is a two story house. LPA viewed the licensed areas which are the living room and requesting the dining area to be added to the licensed. During today's visit LPA conducted a walk through of licensed area and dining room. The second level floor, the garage, and kitchen areas are now the only areas that are off limits. The dining room area is next to the kitchen. In the dining area it was observed a baby gate is placed to separate the dining room and kitchen, inside the cabinets were safety locks to make them inaccessible, and soft mats were observed on the floor.

Based on LPAs observation the dining room meets regulations and will be added to the facility sketch.

An exit interview was conducted, appeal rights given. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was read and reviewed with the license

Licensee posted the updated LIC999A in the facility.




SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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