Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370772
Report Date: 09/18/2017
Date Signed: 09/18/2017 04:57:00 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: 8DATE:
09/18/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
04:46 PM
MET WITH:Mr. AfazTIME COMPLETED:
05:20 PM
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Complaint Specialist (CS) Hundley and Licensing Program Analyst Connolly conducted an inspection to review corrections from prior visit. CS and LPA toured the facility to take census. The census was 3 staff caring for 8 infants. Facility is in compliance with Title 22 regulations at the time of visit.

Exit interview conducted.



THE 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 $100.00. THE 'NOTICE OF SITE VISIT' WAS POSTED ON THE DOOR.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Minerva HundleyTELEPHONE: (714) 703-2834
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2017
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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