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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370408
Report Date: 12/02/2025
Date Signed: 12/02/2025 02:14:58 PM

Document Has Been Signed on 12/02/2025 02:14 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PACIFIC DRIVE ELEMENTRY SCHOOLFACILITY NUMBER:
304370408
ADMINISTRATOR/
DIRECTOR:		COSGROVE, MARILEEFACILITY TYPE:
850
ADDRESS:1501 W. VALENCIA DRIVE, #33TELEPHONE:
(714) 447-7735
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 10DATE:
12/02/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Facility representative, Linda PrietoTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 12/2/2025 at 1pm, Licensing Program Analyst (LPA) Sarah Garcia conducted a follow up case management- incident visit in response to a self-reported unusual incident report (LIC 624) received on 09/16/25 regarding alleged personal rights violation. LPA met with facility representative, Linda Prieto. A walk through of the facility was conducted, and census was taken. Total census was 10 preschool children and 5 staff. A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 09/16/2025, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 09/11/25, Child 2 (C2) disclosed that Staff 4 (S4) allegedly hit them on the back. Later that day, the authorized representative of Child 1 (C1) disclosed that Staff 3 (S3) allegedly hit them on the hand. On 9/12/2025, authorized representatives of C1 and C2 spoke with Staff 1 (S1) regarding the incident. S3 has been put on administrative leave and S4 has not returned to facility. Reporting Party (RP) stated the incidents have been reported to HR, Police, Child Protective Services (CPS), and licensing.

During the investigation, LPA interviewed reporting party, 7 staff, obtained incident report, C1 and C2 emergency information (LIC 701), police report, preschool roster, and staff roster.

All staff interviewed stated they have not witnessed any staff handling children in a rough manner.

Based on LPAs record review and interviews there was not enough evidence to determine violation of personal rights. No deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Exit interview conducted and report was reviewed with facility representative, Linda Prieto. A notice of site visit was given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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