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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371468
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:41:16 PM

Document Has Been Signed on 09/19/2022 04:41 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
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: 20CENSUS: 8DATE:
09/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lucero Rubi, DirectorTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst, (LPA) P Rivas conducted an unannounced case management visit to investigate a self reported incident that occurred on 09/15/22 at approximately 4:10pm. LPA was met by Staff Sonia Tobar
Upon entrance, LPA toured infant room and toddler room. S2 was caring for 3 infants no other teacher in room. Ms. Sonia was caring for 6 toddlers;
An unusual incident report was submitted to the Department advising that Child1(C1) was having their diaper changed when child rolled and fell from the changing table. LPA was advised that Staff1(S1) was present and had bent down to get supplies, when another child made a noise and staff looked over. Director reports that S1 never left the changing table area.. The staff notified Director via text.. Director was completing transportation. C1 was picked up by authorized representative at approximately 4:20pm but S1 failed to advise authorized representative of incident. at pick up. Director reports she notified authorized representative at 4:35pm.. Director has added a a wood panel approx 7 inches tall to changing table as a barrier so now all four sides are enclosed..

During today's visit LPA interviewed Director, reviewed two staff files, 2 children files, reviewed video of incident.
Due to insufficient information available at this time further investigation is required.
Director will submit copy of sign out sheet for C1 and will try to obtain copy of ouch report from parent and submit to LPA. by 09/30/22.

The following deficiencies are cited under the California Code of Regulations Title 22 Chapter 1 ( on 809d)
101416.2(b) Infant Care Teacher Qualifications and Duties
101419.2(b)(2)Infant Needs and Services Plan

Civil Penalties will be issued for a repeat violation


SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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 3
Document Has Been Signed on 09/19/2022 04:41 PM - It Cannot Be Edited


Created By: Pat Rivas On 09/19/2022 at 02:51 PM
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: SERENDIB ANAHEIM LLC, DBA LITTLE MINDS LEARNING AC
FACILITY NUMBER: 304371468

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
101416.2(b)

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Infant Care Teacher Qualifications and Duties
Prior to employment, an infant care teacher shall have completed, with passing grades, at least three postsecondary semesters or equivalent quarter units in early childhood education or child development, AND three
quarter units in early childhood education or
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Licensee will submit in writing that they will not have unqualified teachers caring for children. and S1 will complete infant course this weekend. and provide LPA with copy of certification by 09/30/22
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child development, and three postsecondary semester or equivalent quarter units related to the care of infants, at an accredited or approved college or university . This requirement was not met as evidenced by review of two staff files. S1 did not have any infant units prior to employment; S2 did not have 3 units in early childhood education or development. this poses a potential hazard to children in care.
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Type B
09/30/2022
Section Cited
CCR101419.2(b)(2)

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 Infant Needs and Services PlanThe needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.
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Director implemented keeping a binder with each child's Infant sleeping plan in the infant room in order to keep checks and balances; C1 has disenrolled and director is unable to obtain infant sleeping plan. LPA viewed citation corrected during visit.. Civil penalty stopped
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Review of 1 of 2 Children's files did not have an infant sleeping plan in file(C1). This is a potential risk to children in care; Director state she gave plan to parent and it was not returned ; C1 admitted 050222.
Civil penalty will be issued
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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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022


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: 09/19/2022
NARRATIVE
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101195 Penalties
When a child care center is cited for a deficiency and violates the same regulation subsection within a 12-month period, the child care center shall be cited and an immediate penalty of $250 per cited violation shall be assessed for one day only. Thereafter, a penalty of $50 per day, per cited violation, shall be assessed until the deficiency is corrected.
LPA was advised that director does not do the hiring of employees.

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: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC809 (FAS) - (06/04)
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