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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371585
Report Date: 06/30/2025
Date Signed: 06/30/2025 11:17:57 AM

Document Has Been Signed on 06/30/2025 11:17 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:KIDDIE ACADEMY OF BUENA PARKFACILITY NUMBER:
304371585
ADMINISTRATOR/
DIRECTOR:		BARBA, KARLAFACILITY TYPE:
850
ADDRESS:7501 COMMONWEALTH AVENUETELEPHONE:
(714) 752-6294
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 114TOTAL ENROLLED CHILDREN: 114CENSUS: 47DATE:
06/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Barba, Karla (Director) TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Vivian Trinh conducted an on-site inspection for a self-reported incident on 5/20/25. The Director, Karla Barba, was informed of the purpose of the visit, and a tour of LPA around the center was completed. The census included 47 preschool children and 6 staff members.

A review of the Facility Personnel Report Summary conducted on today’s date 6/30/25 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 5/20/2025, an Unusual Incident Report was filed with the Department to self-report an incident that occurred on 5/19/2025. It was reported that Child #1 exhibited inappropriate behaviors with other children in the class, and the facility had taken action to address concerns about the child’s inappropriate behavior.

During the investigation, LPA interviewed four (4) staff members, five (5) children, and four (4) parents, obtained a copy of the children's roster, LIC 500, C1’s incident report, child 1 and child 2 files, facility roster, and the email notification from teacher to C1’s parents, and LIC 855 declaration from the director and 3 other staff members.

LPA interviewed four (4) staff members. Two (2) out of four (4) witnessed on the camera footage the incident in which Child 2 (C2) exhibited inappropriate behaviors to Child 1 (C1) while at lunchtime. LPA interviewed four (4) parents. None of the parents had any concerns about the facility.

Continued Page 2.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2025
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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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: KIDDIE ACADEMY OF BUENA PARK
FACILITY NUMBER: 304371585
VISIT DATE: 06/30/2025
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During the interview, C1 stated and demonstrated to LPAs how C2 reached over to C1’s lap during lunchtime. C1 also noted that it had happened before. All four (4) staff members did not witness any incident at that moment until Staff 3 and Staff 4 viewed the camera footage. The director had a meeting with teachers and parents to plan a suitable curriculum for C2 and other children related to self-awareness and body awareness

During the record review and declarations from Staff three (3), and Staff four (4), it was observed that C2 reached over C1's lap during lunchtime. According to the incident report and the letter from the facility to C1’s parents, it was explained that C2 exhibited inappropriate behavior toward C1.

Based on LPA interviews and record review, the following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: CCR 101229(a)(1) Responsibility for Providing Care & Supervision. Please refer to the attached 9099D for documentation of deficiencies.

An exit interview was conducted. The Notice of Site Visit was posted for at least 30 consecutive days. Appeal Rights were explained.

The End of Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/30/2025 11:17 AM - It Cannot Be Edited


Created By: Vivian Trinh On 06/30/2025 at 09:37 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: KIDDIE ACADEMY OF BUENA PARK
FACILITY NUMBER: 304371585

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2025
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary.. (1)No child(ren) shall be left without the supervision of a teacher...Supervision shall include visual observation. This requirement is not met as evidenced by..
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The director stated that they will update the curriculum to include self-awareness and body awareness. They will ask upper management to purchase books and provide training for staff. The director will submit a written plan to the LPA before the due date, including all staff training signatures.
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Based on interviews and declarations from staff 3 (S3) and staff 4 (S4) witnesses on the camera footage of the incident in which Child 2 (C2) exhibited inappropriate behaviors to Child 1 (C1) while at lunchtime. This is an immediate risk to the health and safety of 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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2025


LIC809 (FAS) - (06/04)
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