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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371251
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:21:04 PM

Document Has Been Signed on 05/01/2024 12:21 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:CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCHFACILITY NUMBER:
304371251
ADMINISTRATOR/
DIRECTOR:		WELCH, AMBERFACILITY TYPE:
830
ADDRESS:20400 FAIRMONT CONNECTORTELEPHONE:
(714) 290-3993
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 19TOTAL ENROLLED CHILDREN: 19CENSUS: 7DATE:
05/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Director Amber WelchTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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On 5/1/24, at 11:20am, Licensing Program Analyst (LPA) Anna Chan conducted a Plan of Correction (POC) inspection in response to a Type B violation issued on 04/04/24, 101439(h)(4) Infant Care Center Fixtures, Furniture, Equipment and Supplies. LPA met with Director Amber Welch and was informed of the reason of visit. Current census observed was 7 infants and 3 staff.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The areas cited were re-inspected and found not corrected. The facility was given until 4/30/24 to correct the deficiency. Based on LPA observation on 5/1/24, the changing table is not within arm’s reach of a sink. The new changing table was not installed as mentioned on the POC dated 4/4/24. The changing table was still next to food prep area. Director stated the installation of the new changing table and sink will be initiated 5/2/24.

In the areas that were evaluated, a Type B deficiency was observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. 101439(h)(4) Infant Care Center Fixtures, Furniture, Equipment and Supplies See LIC 809D for deficiency. A civil penalty was assessed today due to failure to correct deficiency previously cited on 04/04/2024.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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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: CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCH
FACILITY NUMBER: 304371251
VISIT DATE: 05/01/2024
NARRATIVE
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Exit interview conducted and report was reviewed with the director Amber Welch. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights and deficiencies were explained. The director was provided a copy of appeal rights (LIC 9058 01/16) 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 to the address listed above.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/01/2024 12:21 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 05/01/2024 at 11:54 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: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2024
Section Cited
CCR
101439(h)(4)

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(h) Infant changing tables shall: (4) While in use, be placed within arm's reach of a sink.

This requirement is not met as evidenced by:
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Director stated that the new sink will be installed by 5/8/24. Photos of new sink and changing table will be provided to LPA by due date of 5/8/24
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Based on observation and interview, the licensee did not comply with the section cited above. The infant changing table is not within arm's reach of a sink and previous deficiency cited on 4/4/24 was not corrected, which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Martha Malane
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024


LIC809 (FAS) - (06/04)
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