Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370772
Report Date: 04/12/2016
Date Signed: 04/12/2016 12:10:24 PM

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:HAPPY MINDS KIDS ACADEMYFACILITY NUMBER:
304370772
ADMINISTRATOR:AFAZ, FASHANAFACILITY TYPE:
830
ADDRESS:24000 ALICIA PARKWAY # 35TELEPHONE:
(949) 455-1212
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:16CENSUS: 14DATE:
04/12/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:DirectorTIME COMPLETED:
12:30 PM
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The purpose of this visit was to conduct an annual visit of the facility. Licensing Program Analyst (LPA) Malek met with director, Fashana Afaz who was supervising the children in the classroom at the time of the visit. For this visit, the key indicator tool kit # 2 was used. LPA toured the facility inside and outside. At the time of the visit There were a total 114 infants and toddlers with 4 staff in two different classrooms observed. Medication, food storage, sign in/out, 1st aid/CPR, cleaning supplies storage, Carbon Monoxide, and drinking water were inspected. Posting requirements were reviewed. Staff records and children's files were reviewed at this visit. LPA was informed by the director that this facility provides Incidental Medical Services (IMS) to children. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA Malek discussed with the director the requirements for updating the facility Plan of Operation to include the type of IMS they offer. The facility representative was informed that the facility needs to update and amend the facility Plan of Operation to include the Incidental Medical Services (IMS).
A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Notice of Site Visit was posted. Facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The director was provided a copy of their appeal right (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the updates. Also the information about Integrated Pest Management ( IPM) or the Healthy Schools Act, Department of Pesticide Regulation's child care IPM website was given.www.cdpr.ca.gov/schoolipm/childcare). This report is to be on file and accessible for public review at the facility for at least 3 years. Exit interview was conducted.
In the areas evaluated, no deficiency was observed and cited today per CA Code of Regulations, Title 22, and Division 12.
SUPERVISOR'S NAME: Dana WilliamsonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2016
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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