304370547-5-26-2026-06-CC-CSUN-DUFLUY-20260526090443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370547
Report Date: 05/26/2026
Date Signed: 05/26/2026 09:04:53 AM

Document Has Been Signed on 05/26/2026 09:04 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	SAUSD/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAM		FACILITY NUMBER:	304370547
ADMINISTRATOR/ DIRECTOR:	MEDRANO, PATRICIA		FACILITY TYPE:	850
ADDRESS:	1405 FRENCH STREET		TELEPHONE:	(714) 564-2200
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92701
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 20	DATE:	05/26/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:25 AM
MET WITH:	Early Learning Specialist; Laura Barnett		TIME VISIT/ INSPECTION COMPLETED:	09:30 AM

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Licensing Program Analysts (LPA) Cynthia Sun conducted an unannounced case management inspection in response to a self-report Unusual Incident dated 5/04/2026. LPA met with Early Learning Specialist Laura Barnett. Census was taken as follows: 3 staff supervising 9 preschool children in Room #30 and 3 staff supervising 11 preschool children in Room #31.

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 5/4/26, Regional Office received a self-reported Unusual Incident Report (UIR) stating that on 5/1/26, at 11:17am, during outside time, child #1 (C1) was running near a tree, C1 tripped on the playground tree roots, C1 fell and hit C1’s head on the left side near C1 temple. Staff #1 (S1) immediately ran to C1 and gave C1 first aid. S1 asked Staff #3 (S3) to get ice while S1 was giving C1 first aid. S1 called C1’s parent #1 (P1) and P1 picked up C1 at 12:01pm. S1 also talked to the school nurse who provided a referral for C1 to go to the doctor. C1 returned to school on 5/4/26.

During inspection, LPA interviewed facility staff. S1 stated the incident happened on 5/01/26 around 11:17 AM. S1 stated the following: S1 didn’t witness the incident because S1 was re-directing another child who was running in the playground.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAM	FACILITY NUMBER: 304370547
	VISIT DATE: 05/26/2026

NARRATIVE

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S1 was 7 steps away from C1 and heard C1 crying, S1 saw C1 was on the ground crying. S1 ran to tend to C1. S1 saw blood on C1’s head; S1 put gloves on and helped C1 get up and walk to get first aid. S1 saw C1 had a cut on left side near temple. S1 asked S3 to go get ice for C1. S1 cleaned C1 and called front office for nurse, nurse was not in office. Then, S1 called the ECE nurse and ECE nurse stated if there was a lot of blood or if blood kept coming out to call C1’s parent. S1 called P1 two times. P1 picked up call on second time and P1 stated P1 was on her way to facility. P1 eventually picked up and signed the child out C1 maybe around 11:45 AM. S1 provided P1 with paperwork to take to the doctor (head injury follow-up and incident report).
Staff #2 (S2) stated S2 was in the playground helping three children. S2 heard C1 crying and started looking to see who was crying and saw S1 got to C1 first. S1 was tending to C1 while S2 tended to the rest of the class. Staff #3 (S3) stated S3 was not in the playground when C1 got hurt, S3 went to the restroom. When S3 returned to the playground S1 asked S3 to go get ice pack for C1.

LPA also interviewed children. C1 stated C1 was running with friend and slipped. C1 stated “C1 was crying and S3 gave me ice for my head. Then my mom came to school and took me to the doctor. The doctor looked at my cut and put glue on my cut. That is it. I am OK now”. C1 showed LPA where C1 fell in playground. C1 stated C1 got hurt near tree by side of gate, C1 thinks C1 slipped with tree leaves. C1 was not sure what C1 hit head on. C1 did not remember where his teachers were standing when C1 got hurt. Child #3 (C3) stated C3 was playing hide and seek with C1. C3 stated C1 was hiding by the tree and C1 got hurt. C1 was bleeding and C3 went to get S2. By this time, S1 was already helping C1. C3 showed LPA where C1 fell. C3 thinks C1 slip on the tree leaves.

Early Learning Specialist stated, after the incident happened, the following action has been implemented to prevent further accidents:
1. Maintenance will go out to facility and scrape down erupting tree roots coming out from the ground in children’s playground.
2. Staff will continue to place small cones to prevent children from playing near tree areas.
3. Staff will conduct safety lesson for children to stay out of tree areas near playground gates.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SAUSD/DAVIS ELEM. SCHOOL-KINDER READINESS PROGRAM	FACILITY NUMBER: 304370547
	VISIT DATE: 05/26/2026

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Based on LPA’s record review and interviews conducted, there is no evidence to support any violation of Title 22 regulations. No deficiency cited during today's inspection.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door.

End of Report

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Cynthia Sun
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026

LIC809 (FAS) - (06/04)

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