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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370109
Report Date: 11/18/2021
Date Signed: 11/18/2021 12:20:14 PM

Document Has Been Signed on 11/18/2021 12:20 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:JCC EARLY CHILDHOOD LEARNING CENTERFACILITY NUMBER:
304370109
ADMINISTRATOR:MONETTE, LISAFACILITY TYPE:
850
ADDRESS:1 FEDERATION WAY, STE. 200TELEPHONE:
(949) 435-3400
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY: 340TOTAL ENROLLED CHILDREN: 215CENSUS: 176DATE:
11/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Sheila Dalva-Hornback, Interim DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst Nguyen Tran conducted a case management visit to interview a child regarding an incident that is not associated to this facility. LPA Tran met with Interim Director Sheila Dalva-Hornback and toured the facility.
At 11:45 am census was taken. Observed were 176 preschool age children with 36 teachers. During today's inspection staffing ratios were being met and the facility was operating within its licensed capacity. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

After interviewing with Director and reviewing of children roster, it was determined that child does not attend this facility.

Exit interview was conducted with Interim Director, Sheila Dalva-Hornback. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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