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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371572
Report Date: 11/20/2023
Date Signed: 11/20/2023 11:22:49 AM

Document Has Been Signed on 11/20/2023 11:22 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:TUSTIN PRESCHOOLFACILITY NUMBER:
304371572
ADMINISTRATOR:REN, YULANDFACILITY TYPE:
850
ADDRESS:14211 NEWPORT AVENUETELEPHONE:
(714) 838-3480
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 15DATE:
11/20/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Director Jeanette TrujilloTIME COMPLETED:
11:40 AM
NARRATIVE
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On 11/20/23, Licensing Program Analyst (LPA) Anna Chan conducted an unannounced Case Management visit. LPA met with staff Fara Farrahi to discuss the Lead Sampling Testing. Census was taken and there are 15 children and 3 staff. Director arrived at around 9:47am.

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.

On 8/17/23 LPA cited the facility for not testing their water for Lead Sampling.

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).

During today’s visit, LPA verified with Director Jeanette Trujillo that the lead testing was still NOT completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Violations Warranting an Immediate Civil Penalty Assessment of $250 is hereby assessed today, November 20, 2023. If violation is not cleared by due date of November 27, 2023, a progressive penalty of $100 per violation, per day will apply.


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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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Document Has Been Signed on 11/20/2023 11:22 AM - It Cannot Be Edited


Created By: Anna Francesca Chan On 11/20/2023 at 10:20 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: TUSTIN PRESCHOOL
FACILITY NUMBER: 304371572

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2023
Section Cited
HSC
1597.16(a)(1)

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Lead Testing (1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010 ...

This requirement is not met as evidenced by:
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The director stated that the facility will do the lead testing tomorrow 11/21/2023.
Director stated she will send LPA a proof of Lead Testing via email by due date of 11/27/23
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Based on interview, the Director stated that the facility has not conducted Lead Testing which poses a health and safety risk to children 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:Judy Hanson
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2023


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: TUSTIN PRESCHOOL
FACILITY NUMBER: 304371572
VISIT DATE: 11/20/2023
NARRATIVE
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CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE.
A Type B violation was observed in accordance with Health and Safety Code 1597.16(a)(1) Lead Testing, is being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with Director Jeanette Trujillo. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights and deficiency were explained. The Director was provided a copy of 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. First level appeals should be sent to the regional manager to the address listed above.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC809 (FAS) - (06/04)
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