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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370580
Report Date: 10/14/2024
Date Signed: 10/14/2024 05:22:01 PM

Document Has Been Signed on 10/14/2024 05:22 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:APPLE TREE LEARNING ACADEMYFACILITY NUMBER:
304370580
ADMINISTRATOR/
DIRECTOR:		SUK, JUNG H.FACILITY TYPE:
850
ADDRESS:2338 EAST WAGNER AVENUETELEPHONE:
(714) 284-0706
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 9DATE:
10/14/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:05 PM
MET WITH:Director SukTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 10/14/2024, Licensing Program Analyst (LPA) A. Silva conducted a Case Management – Deficiencies due to deficiencies observed during a visit. LPA informed Director Jung H. Suk of the purpose of the Case Management. A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance. The census at the time was 9 children.

During the visit, the director disclosed that a log of persoonel hours worked is not kept. The director was informed that according to 101217(e) Personnel Records In all cases, personnel records shall document the hours actually worked.

The facility was not in compliance. Violations of CCR Title 22 were cited during today’s visit including 101217(e) Personnel Records.

Appeal Rights were discussed. The facility representative 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 provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with the daycare representative.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
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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Document Has Been Signed on 10/14/2024 05:22 PM - It Cannot Be Edited


Created By: Archibaldo Silva On 10/14/2024 at 05:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: APPLE TREE LEARNING ACADEMY
FACILITY NUMBER: 304370580

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2024
Section Cited
CCR
101217(e)

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101217(e) Personnel Records. In all cases, personnel records shall document the hours actually worked.
This requirement is not met as evidenced by
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The director will create a log and document the personnel hours actually worked. The director will email proof of correction by the due date.
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Based on interview statements, the director did not ensure documentation of the hours actually worked by facility personnel. The director stated that hours worked are not kept for S1, S3, and S4.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Patricia Magana
LICENSING EVALUATOR NAME:Archibaldo Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2024


LIC809 (FAS) - (06/04)
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