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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370734
Report Date: 02/07/2025
Date Signed: 02/07/2025 03:45:33 PM

Document Has Been Signed on 02/07/2025 03:45 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:FUN 4 KIDS PRESCHOOLFACILITY NUMBER:
304370734
ADMINISTRATOR/
DIRECTOR:		ALICIA FLORESFACILITY TYPE:
850
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY: 76TOTAL ENROLLED CHILDREN: 76CENSUS: 5DATE:
02/07/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:46 PM
MET WITH:Director Jennifer HouseTIME VISIT/
INSPECTION COMPLETED:
03:14 PM
NARRATIVE
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On 02/07/25 Licensing Program Analysts (LPAs) Anna Chan and Patricia Duron conducted a case management deficiency report. LPA met with Director Jennifer House and informed the Director of the purpose of the visit. During today's visit, a tour of the facility was conducted. The overall census observed was 5 preschool children and 1 staff.

During a complaint investigation on 02/07/25, it was discovered that 3 staff files have incomplete personnel records, and 1 staff does not have any current personnel records during the inspection.

Staff 1 is missing immunization such as Tdap and MMR, missing current Mandated Reporter Certificate.
Staff 2 is missing current Mandated Reporter Certificate, missing Employee Rights (LIC9052).
Staff 3 is does not have a copy of current driver's license for being the van driver.
Staff 4 no file available to review at the time of visit.

Based on record review and interview, the following Type B deficiency was cited and discussed. The facility was not in compliance with the California Code of Regulations, Title 22, Division 12, Section 101217(a) Personnel Records. Please refer to LIC809D for details of deficiency. Director was provided a copy of the regulations.

Exit interview was conducted. Report and deficiency were discussed. Notice of Site Visit was posted during the visit. Director, Jennifer House informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The 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.
Martha MalaneTELEPHONE: (310) 740-3022
Anna Francesca ChanTELEPHONE: (818) 216-9775
DATE: 02/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2025
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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Document Has Been Signed on 02/07/2025 03:45 PM - It Cannot Be Edited

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: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2025
Section Cited
CCR
101217(a)

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101217(a) Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:
This requirement is not met as evidenced by:
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The director stated they will complete each employee file and will provide a copy of missing documents to LPA by due date of 3/7/25.
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Based on interview and record review, the facility did not maintain current record for 4 employees.
This poses a potential risk to health and safety and personal rights of children in care
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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.
Martha MalaneTELEPHONE: (310) 740-3022
Anna Francesca ChanTELEPHONE: (818) 216-9775

DATE: 02/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2025

LIC809 (FAS) - (06/04)
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