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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603868
Report Date: 07/21/2026
Date Signed: 07/21/2026 03:29:29 PM

Document Has Been Signed on 07/21/2026 03:29 PM - 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:FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCHFACILITY NUMBER:
300603868
ADMINISTRATOR/
DIRECTOR:		MARIETTA GILLIARDFACILITY TYPE:
850
ADDRESS:321 E. CHAPMAN AVE.TELEPHONE:
(714) 992-7070
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 60TOTAL ENROLLED CHILDREN: 33CENSUS: 23DATE:
07/21/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Director, Marietta GilliardTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
NARRATIVE
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On 07/21/2026 at 12:45pm, Licensing Program Analyst (LPA) Sarah Garcia conducted a case management- incident visit in response to a self-reported unusual incident report (LIC 624) received on 07/09/26 regarding a child's injury. LPA met with director, Marietta Gilliard. A walk through of the facility was conducted, and census was taken. LPA observed facility during nap time and total census was 23 preschool children and 2 staff.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 7/9/2026, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 7/7/2026, Child 1 (C1) was playing with wooden blocks in the outdoor block play area and C1 stated they tripped and began crying. Staff 1 (S1) stated C1 may have been lifting up the block and hit their face on the wooden block. Staff did not see the incident but assessed C1 and observed C1's two front teeth appeared pushed back. Authorized representatives contacted and C1 was picked up. Per authorized representatives, C1 was taken to the dentist and the two front teeth were removed. C1 returned on 7/8/26.

During today's inspection, LPA Garcia interviewed 3 staff and obtained facility ouch report, C1's identification form (LIC 700), 7/7/26 attendance sheets, authorized representative "Brightwheel" correspondence, C1's dental visit report, photo of injury.

Continued on Page 2

Tina Nguyen
Sarah Garcia
DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2026
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 4
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: FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCH
FACILITY NUMBER: 300603868
VISIT DATE: 07/21/2026
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Based on interviews, Staff 1 (S1) was present at the time of the incident but did not directly observe the injury therefore C1 was not supervised during the injury. S1 observed C1 in pain after the incident and administered first aid. Staff 2 (S2) was present at the time of the incident but did not observe the injury therefore C1 was not supervised during the injury. S2 was called over by S1 to observed the C1's mouth after the incident to assess injury.

Based on record review, the ouch report stated that on 7/7/26 at approximately 11:40am in the upper yard block area C1 was playing, lifted a block, turned around, and tripped. As C1 fell they got hurt on the teeth with the block they were holding. C1 stated their teeth hurt. The "Brightwheel" correspondence showed the facility provided a picture of C1's teeth to authorized representatives. Per dental record, C1 was seen on 7/7/26 for "necessary oral health care."

Based on record review, interviews, inspection physical plant of the site, it has been determined there was a lack of supervision resulting in a child's injury. According to Title 22, California Code of Regulations, Section 3, Chapter 4, (1) Type A deficiency will be cited today. See attached LIC 809D. LPA provided a copy of regulation Section 101229 for reference.



LPA Garcia informed director, Marietta Gilliard that this report dated 7/21/2026 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, and personal rights to the children in care. Also, LPA Garcia informed director to provide a copy of this licensing report dated 7/21/2026 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months form the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) or other written statement must be kept in the child's file for verification.

Exit interview was conducted with Director, Marietta Gilliard. Appeal rights were discussed and provided to director. The Notice of Site Visit was posted. Director 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.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Tina Nguyen
NAME OF LICENSING PROGRAM ANALYST: Sarah Garcia
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/21/2026 03:29 PM - It Cannot Be Edited


Created By: Sarah Garcia On 07/21/2026 at 02:13 PM
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: FULLERTON COLLEGE CHILD DEVELOPMENT LABORATORY SCH
FACILITY NUMBER: 300603868

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2026
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision of a teacher at any time...shall include visual observation.
This requirement was not met as evidenced by:
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Facility will conduct an all-staff supervision traning and submit training agenda to LPA via email by 5pm on 7/22/2026.
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Based on record review and interviews, on 7/7/26 at approximately 11:40am, while playing in the upper yard, Child 1 (C1) injured their mouth with a wooden block and the two staff present did not visually observe the injury therefore C1 was not supervised during the injury which poses an immediate health and safety right 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.
Tina Nguyen
NAME OF LICENSING PROGRAM MANAGER:
Sarah Garcia
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2026


LIC809 (FAS) - (06/04)
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