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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371468
Report Date: 12/02/2022
Date Signed: 12/02/2022 10:55:26 AM

Document Has Been Signed on 12/02/2022 10:55 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:SERENDIB ANAHEIM LLC, DBA LITTLE MINDS LEARNING ACFACILITY NUMBER:
304371468
ADMINISTRATOR:LUCERO RUBIFACILITY TYPE:
830
ADDRESS:1845 WEST LA PALMATELEPHONE:
(714) 215-4293
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 20TOTAL ENROLLED CHILDREN: 11CENSUS: 6DATE:
12/02/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lucero Rubi, DirectorTIME COMPLETED:
11:00 AM
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LIcensing Program Analyst (LPA) P Rivas conducted an unannounced plan of correction visit for a deficiency cited on 10/27/22 with a due date of 10/31/22. LPA had received written plan of correction dated 10/31/22.

LPA went directly into Infant room and spoke with Staff1(S1). LPA advised S1 reason for visit and included viewing a diaper change. S1 texted Director who was in the Toddler room providing direct care. LPA viewed S1 completing diaper change. Later LPA viewed S2 completing diaper change.

During today's visit LPA took census and noted 1 staff in infant room with 2 infants; 1 staff in toddler room with 4 toddlers. 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 following deficiency was viewed as cleared:
101429(a) 1 Responsibility for Providing Care and Supervision for Infants
Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Director will write out changing diaper procedure and have teacher sign off and each teacher will demonstrate ability to follow correct procedure and send documentation to LPA by plan of correction date. Director provided procedure and verification that staff had demonstrated ability to follow correct procedure. During today's visit LPA observed two diaper changes completed by S1 and S2 , Diaper change completed by S1 had no issues. Diaper change completed by S2 almost missed wiping hands. Interview with Director stated S2 has changed diaper following procedures without incident .
Cont on page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: SERENDIB ANAHEIM LLC, DBA LITTLE MINDS LEARNING AC
FACILITY NUMBER: 304371468
VISIT DATE: 12/02/2022
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No deficiencies noted during today's visit.

Appeal Rights were discussed. Ms. Lucero Rubi 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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022
LIC809 (FAS) - (06/04)
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