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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371091
Report Date: 02/15/2022
Date Signed: 02/15/2022 11:53:25 AM

Document Has Been Signed on 02/15/2022 11:53 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:KINDERLAND ACADEMYFACILITY NUMBER:
304371091
ADMINISTRATOR:SALCEDO, MIRIAMFACILITY TYPE:
850
ADDRESS:1170 W. CIVIC CENTER DRIVETELEPHONE:
(714) 280-4222
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 37DATE:
02/15/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Miriam Salcedo, directorTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Plan of Correction (POC) inspection. LPA and the facility representative toured the facility. Census was taken in individual classrooms. The overall census observed was 37 children and 5 staff. This POC inspection is being done in response to an A violation cited on 2/3/22, in which the 2s classroom was out of compliance, by having 3 children under the age of 2. This violates ratio/limitations of capacity, and is an immediate risk to children's health and safety. During today's inspection, it was observed that all children in care were above the age of 2, and the facility has corrected this A violation. It was observed, however, upon the physical plant inspection, that in the 3s classroom, one staff was supervising 13 children. Another staff who had been in the class supervising the 13 children along with the teacher, had left the classroom and gone on a 10 minutes break. LPA directed the staff to return to the classroom and return the facility to ratio compliance. This was discussed with the director and the Title 22 Ratio Regulations were printed and reviewed with the director.
Based on LPAs observations the following violation(s) was observed and is being cited in accordance with California Code of Regulations, Title 22 Section 101216.3(a), is being cited on the attached LIC 809D.

Due to an A violation being cited the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00. Appeal Rights and deficiencies 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 given and must remain posted for 30 days. Exit interview conducted and report was reviewed with director.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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 02/15/2022 11:53 AM - It Cannot Be Edited


Created By: Dean Valencia On 02/15/2022 at 11:13 AM
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: KINDERLAND ACADEMY
FACILITY NUMBER: 304371091

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/15/2022
Section Cited
CCR
101216.3(a)

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There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. This was not met as evidenced by:

Based on LPA's observations of the 3s classroom, it was observed that one teacher was supervising 13 children for
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The second staff memeber immediatley returned from break and returned the classroom in compliance of ratio. Director met with staff and discussed ratio with them. Proof of the discussion will be emailed to LPA today, 2/15/22.
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approximately 2 minutes. This presents an immediate risk to the children's health and safety.
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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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Valencia
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022


LIC809 (FAS) - (06/04)
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