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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314150
Report Date: 04/24/2023
Date Signed: 04/24/2023 08:17:05 AM

Document Has Been Signed on 04/24/2023 08:17 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CHIBA, SAYORIFACILITY NUMBER:
304314150
ADMINISTRATOR:CHIBA, SAYORIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 733-0521
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/24/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Chiba SayoriTIME COMPLETED:
08:30 AM
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An Informal Office Meeting was conducted on this day in the Orange Regional Office. Present during the meeting were Licensing Program Manager (LPM) Thuy Ho, and Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek. Also present in this meeting was applicant, Chiba, Sayori.

The purpose of this informal meeting is to discuss the operation of the family childcare home with applicant, Chiba, Sayori. Applicant, Chiba, Sayori resides and will operate the family childcare home where adult # 1 resides. Adult # 1 will operate their childcare center located in Santa Ana full time. Chiba, Sayori has a pending childcare home application to operate a family childcare home at the same address of adult #1.

The following was discussed with Chiba, Sayori regarding the operation of pending family childcare home.

Chiba, Sayori will be licensed as a new family childcare home licensee at the same address where adult #1 resides.

There will be no students exchange at these two family childcare home and childcare center during the operation of these two businesses.

The childcare center business and family childcare home business have no interest in each other’s businesses during the operation of each business.

The childcare center operates from 7:30 am to 6:00 pm.

The family home day care operates from 8:00 am to 10:00 pm Monday to Saturday.

Both Chiba, Sayori and adult # 1 shall involve in their own childcare businesses and there will be no interactions between the two businesses.

Continued on page 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHIBA, SAYORI
FACILITY NUMBER: 304314150
VISIT DATE: 04/24/2023
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In circumstances a child may be enrolled in two programs at different timing, the child must have a complete file and proof of enrollment for each program.

LPM explained the presence and the role and responsibility of Chiba, Sayori for the location they work at.



Chiba, Sayori was advised to review the Department's Child Care Video Series at:https://ccld.childcarevideos.org/. for awareness and familiarity of regulations as a licensee; some of the topics include but are not limited to reporting requirements, criminal record clearance, locks, and inaccessibility requirements, and teacher child ratio in childcare facilities. The licensees will check the Department's website www.ccld.ca.gov for any updates on a quarterly basis and will ensure compliance with California Code Title 22 Regulations.

Chiba, Sayori was advised that it is their responsibility to know & understand Title 22 Regulations. The facility must comply with licensing regulations at all times.



End of the reports.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2