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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304370398
Report Date:
07/13/2022
Date Signed:
07/13/2022 12:51:09 PM
Document Has Been Signed on
07/13/2022 12:51 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:
ANAHEIM CITY SCHOOL DISTRICT-HERMOSA VILLAGE
FACILITY NUMBER:
304370398
ADMINISTRATOR:
JELINEK, VIVIANA
FACILITY TYPE:
850
ADDRESS:
1515 CALLE DEL MAR
TELEPHONE:
(714) 517-7518
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92802
CAPACITY:
15
TOTAL ENROLLED CHILDREN:
0
CENSUS:
0
DATE:
07/13/2022
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Lynda Durand, School Readiness Coordinator
TIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced annual inspection and was met by Lynda Durand School Readiness Coordinator. This facility is located inside an apartment complex and the classroom (activity room #1) is located in a community center inside the apartment complex.
Ms. Durand reports the facility has been operating since 08/08/21 and documents to remove from inactive status had been previously submitted.
As of today there are no children present and operation will begin 08/08/22. Ms. Durand has attempted to obtain key for activity room but on-site management has not been available. On site management is out for company outing.
LPA toured the playground and reviewed Director's file.
LPA will continue annual inspection at a later date.
No deficiencies noted during today's visit.
Appeal Rights were discussed. Ms. Durand was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the Ms Durand.
SUPERVISORS NAME
:
Rina Lopez
LICENSING EVALUATOR NAME
:
Pat Rivas
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/13/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/13/2022
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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