304371293-5-5-2026-06-CC-VTRH-DTSQ3X-20260505114926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371293
Report Date: 05/05/2026
Date Signed: 05/05/2026 11:50:06 AM

Document Has Been Signed on 05/05/2026 11:50 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	BOYS & GIRLS CLUBS-SKYLARK		FACILITY NUMBER:	304371293
ADMINISTRATOR/ DIRECTOR:	NAVA, MARISSA		FACILITY TYPE:	850
ADDRESS:	11250 MAC MURRAY STREET		TELEPHONE:	(714) 497-7382
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 29	CENSUS: 15	DATE:	05/05/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Sarah Pham (Director)		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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On 5/5/2026, Licensing Program Analyst (LPA) V. Trinh conducted an on-site inspection for the purpose of an Annual Inspection. LPA and the Facility Program/Director, Sarah Pham, toured the facility inside and outside, and the floor and yard plan (LIC 999) were verified. The census was taken in individual classrooms. The overall census observed was 24 preschool children and 5 Preschool teachers. The Program/Director stated that the total enrollment is 29 preschool children, that children are on a staggered schedule and arrive at different times throughout the day, and that they are aware that they cannot exceed the capacity ratio of 48 children at any one time. During the inspection, it was determined that the facility is operating within its licensed capacity and in compliance with staff-to-child ratios. Facility hours are 7:00 a.m.- 6:00 p.m., Monday through Friday.

CRIMINAL RECORD CLEARANCE: A review of the Facility Personnel Report Summary on this date, 05/05/2026. The Program/Director understands that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption or transfer their existing clearance or exemption prior to the initial presence in a licensed childcare facility. Violation of this requirement will result in a citation of a deficiency and civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

INDOOR INSPECTION: The LPA inspected the indoor areas and areas accessible to children at the time of the visit. The facility was equipped with working carbon monoxide and smoke detectors, working telephone service, and at least one fire extinguisher that meets statutory and State Fire Marshall standards. A record review shows that the last drill was documented on May 1, 2024. The Program/director stated that there are no firearms and/or other dangerous weapons in the facility; none were observed during the inspection. Detergents, cleaning compounds, medicines, and other items that could pose a danger if readily available were inaccessible to clients in care.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 05/05/2026 11:50 AM - It Cannot Be Edited

Created By: Vivian Trinh On 05/05/2026 at 10:30 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: BOYS & GIRLS CLUBS-SKYLARK	FACILITY NUMBER: 304371293
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review. The licensee did not comply with the section cited above. At 9:00 A.M, during staff file review and interview, staff 2 (S2) members did not have their mandated reporter training certificate, which expired 12/16/25, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/08/2026
	Plan of Correction
1 2 3 4	The program/director states that they will ask S2 complete the updated Mandated Reporter training and submit the certificate to LPA by the due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:

	Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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: BOYS & GIRLS CLUBS-SKYLARK	FACILITY NUMBER: 304371293
	VISIT DATE: 05/05/2026

NARRATIVE

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No poisons or other items that could pose a danger to children were observed during the inspection. Solid waste receptacles have a tight-fitting cover and are in good repair. The facility provides age-appropriate toys, play equipment, and materials for the children served.

ON-SITE FOOD PREPARATION: This facility provides breakfast, lunch, and PM snacks, which are delivered by a vendor called the Great American Lunchbox, and Menus were posted where they could be reviewed by parents. At the time of inspection, food prep areas were clean and sanitary, and food was properly stored. Drinking water is available to children indoors by bringing their own water bottles from home with the child’s name on it. There is a water fountain in each classroom, and a water jug for refills.

Drinking water is available to children in care. The LPA observed that the facility’s floors, equipment, furniture, and children’s bathrooms were clean, in good repair, and free of sharp edges. The facility meets all posting requirements.

OUTDOOR INSPECTION: The LPA inspected the outdoor areas. The playground is enclosed by a fence at least four feet high and is in good repair. At the time of inspection, the surface of the outdoor activity area was maintained and free of any observable hazards. The areas around and under high-climbing equipment, swings, slides, and similar equipment were cushioned with impact-absorbing material. The outdoor equipment and toys are in good repair and free of sharp edges. There is drinking water available to children indoors by a sports bottle with the children’s names or a water fountain with paper cups. There are no bodies of water present at the facility. The inspected grounds of the outdoor facility are safe, sanitary, and in good repair. The children's bathrooms are clean and sanitary.

PERSONNEL RECORDS. Staff files were reviewed for staff present during the facility inspection on this 05/05/26; 5 out of 5 staff files were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states that a person shall not be employed or volunteer at a child day care center if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis and measles for staff members was reviewed and in compliance. Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporting training and to renew it every 2 years. At 9:00 A.M, during staff file review and interview, staff 2 (S2) members did not have their mandated reporter training certificate, which expired 12/16/25. At least one staff member present has current EMSA-approved Pediatric CPR/First Aid certification on 8/5/26.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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: BOYS & GIRLS CLUBS-SKYLARK	FACILITY NUMBER: 304371293
	VISIT DATE: 05/05/2026

NARRATIVE

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CHILDREN’S RECORDS: Children's records were reviewed for compliance present during the facility inspection on this date; 5 out of 5 children's files were reviewed. Each child has a separate, complete, and current record. The sign-in/out procedure was reviewed for compliance. Transportation is offered to children. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and a link to the publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

The Program/Director was informed that Licensing Quarterly Updates are available at www.cdss.ca.gov Director may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.cdss.ca.gov

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Information on the additional nutrition training, immunization requirements for children, and Health Schools Act (http://www.cdpr.ca.gov/docs/pestmgt/schoolipm.htm) was provided. The facility representative was informed, and the website given, that the California Child Care Disaster Plan has been posted to the UCSF California Childcare Health Program website: cchp.ucsf.edu/content/disaster-preparedness. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the facility representative.

LEAD TESTING: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. The director submitted LIC 9275 and LIC 9276. The Water Board website shows no lead exceedance.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

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: BOYS & GIRLS CLUBS-SKYLARK	FACILITY NUMBER: 304371293
	VISIT DATE: 05/05/2026

NARRATIVE

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CRIMINAL RECORD CLEARANCE: The program/director understands that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the initial presence in a licensed child care facility. Violation of this requirement will result in a deficiency citation and civil penalties of one hundred dollars ($100) per violation per day for up to five (5) days. Subsequent violations within a twelve (12) month period will result in a civil penalty of one hundred dollars ($100) per violation per day for a maximum of thirty (30) days in accordance with Section 1596.871 of the Health and Safety Code.

Based on LPA record review, the facility was not in compliance and is being cited in accordance with the Health and Safety Code, for the following violations: HSC 1596.8662(b)(1) Administration of Child Day Care Licensing on the attached LIC 809D.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Appeal Rights and deficiencies were discussed. The facility Program/Director was provided a copy of their appeal rights. A notice of site visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with the program/director.

End of my Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/05/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026

LIC809 (FAS) - (06/04)

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