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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304370736
Report Date:
09/14/2023
Date Signed:
09/14/2023 11:16:22 AM
Document Has Been Signed on
09/14/2023 11:16 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
CCLD Regional Office
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
FUN 4 KIDS PRESCHOOL
FACILITY NUMBER:
304370736
ADMINISTRATOR:
WOJCIK, MELISSA
FACILITY TYPE:
840
ADDRESS:
23721 LA PALMA AVENUE
TELEPHONE:
(714) 694-0901
CITY:
YORBA LINDA
STATE:
CA
ZIP CODE:
92887
CAPACITY:
30
TOTAL ENROLLED CHILDREN:
30
CENSUS:
0
DATE:
09/14/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
10:15 AM
MET WITH:
Director, Melissa Wojcik
TIME COMPLETED:
11:30 AM
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A Case Management inspection conducted on 09/14/23 by Licensing Program Analyst (LPA) Dianna Valdez Santana to issue an amended Complaint report dated 09/07/2023. Met with Director Melissa Wojcik. LPA observed 1 school-age staff and 0 school-age children in care during today's visit.
Please see "Amended" report dated 09/07/2023 9099 for correction.
Exit interview was conducted with facility representative.
SUPERVISORS NAME
:
Thuy Ho
LICENSING EVALUATOR NAME
:
Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/14/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/14/2023
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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