Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370772
Report Date: 03/13/2018
Date Signed: 03/13/2018 03:31:21 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:18CENSUS: 13DATE:
03/13/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Assistant director and directorTIME COMPLETED:
02:15 PM
NARRATIVE
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An unannounced Annual Random inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek who met with assistant director, Yvonne Smith. The director Fashana Afaz arrived during LPA's visit. Census was taken and there were a total of 13 infants and toddlers with 4 staff in 2 different rooms. There were 3 awaked infants with 2 staff in the activity area and 4 napping infants with one staff in the crib area in the infant room. There were 6 napping toddlers with one staff observed in the toddler room. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture was inspected to ensure it's in good condition, free of sharp, loose or pointed parts. The bins had tight fitting covers. The napping area is separated from the activity are and has sufficient infant napping equipment. There is no walkers on the premises. The changing table is within the arm's reach of a sink. Bottles and dishes were checked in the refrigerator. They were labeled with the name of the child and current date. The infants and toddlers were being supervised in the awake and napping area. There are no weapons, firearms or bodies of water in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Staff's files were reviewed for education verification, CPR/First Aid, infant/toddler units, and new immunization requirements for (MMR, Pertussis, and Flu vaccines).
A sample of children's files were reviewed for completeness of medical assessment, and verification of sign in/out including time the child was signed in/out by authorized representative as well as verification of representatives full legal signature.
The facility has an individual feeding plan for each infant and each infant has an infant Needs and Services Plan. The facility does provide Incidental Medical Services-IMS. LPAs reviewed storage of medication and

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2018
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 2
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: HAPPY MINDS KIDS ACADEMY
FACILITY NUMBER: 304370772
VISIT DATE: 03/13/2018
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equipment/supplies, and reviewed children’s, personnel, and administrative records. There are currently no infants and toddlers with IMS. When any IMS is provided, a Plan for Providing IMS has been submitted to our office in June 2016. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The facility has submitted an updated plan for providing Incidental Medical Services (IMS) to our office.
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 licensee was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.First level appeal is to Regional Manager, address is above on the report. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

A copy of child care provider's guide to safe sleep pamphlet and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative today.

In the areas that were evaluated, the facility was in compliance of the California Code of Regulations, Title 22, Division 12. No deficiency was cited.

This report ends here.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2018
LIC809 (FAS) - (06/04)
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