<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371251
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:16:54 AM

Document Has Been Signed on 11/30/2023 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCHFACILITY NUMBER:
304371251
ADMINISTRATOR:WELCH, AMBERFACILITY TYPE:
830
ADDRESS:20400 FAIRMONT CONNECTORTELEPHONE:
(714) 290-3993
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 6DATE:
11/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:WELCH, AMBERTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) A. Bootorabi conducted an unannounced case management visit on 11/30/2023.
The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Upon staff file review it was determined that 1 of 3 staff did not have a mandated reporter training and 1 of 3 staff had an expired mandated reporter training. 1 of 3 files reviewed did not have a physical exam and immunization on file. A consultation was provided. A copy of LIC 311 was provide and LIC 125.

A copy of infant safe sleep regulations was provide to the director during today's visit.

A consultation was given to the director for the facility roster matching the LICv9040 form during today's visit.

The facility did not meet the California Code of Regulations, Title 22 Division 12, and regulations not met were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today:
1596.8662(b)(1)
Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative WELCH, AMBER.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) 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. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/30/2023 11:16 AM - It Cannot Be Edited


Created By: Araceli Bootorabi On 11/30/2023 at 11:02 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: CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCH
FACILITY NUMBER: 304371251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2023
Section Cited
HSC
1596.8662(b)(1)

1
2
3
4
5
6
7
1596.8662(b)(1)... employee of a licensed child day care facility shall complete the mandated reporter training... and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
The licensee did not comply with the section cited above by means of not having a complete and up to date mandated reporter training for S1 and S2 during today's inspection which poses a potential health and safety risk for children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2