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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600175
Report Date: 12/07/2023
Date Signed: 12/18/2023 11:33:21 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2023 and conducted by Evaluator Mahnaz Malek
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20231020082712
FACILITY NAME:OUR SAVIOR'S LUTHERAN PRESCHOOLFACILITY NUMBER:
300600175
ADMINISTRATOR:RIVAS, AMYFACILITY TYPE:
850
ADDRESS:200 SAN PABLOTELEPHONE:
(949) 492-6165
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY:116CENSUS: 23DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Director, Amy RivasTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not prevent child from being touched inappropriately by another child while in care
Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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Page 1 of
Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a follow up investigation regarding the above allegations. This is a follow-up for the visits conducted on 10/23/2023. LPA met with the director, Amy Rivas. There was a total of 23 children with 4 staff in one classroom and on two playgrounds.

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

Our office has received a complaint report regarding the above allegations. According to the report, inappropriae touching occured between two 3-year-old children (child# 1 and 2) on the playground during outside time. It was reported staff # 1 did not witness the incident but staff # 2 saw it happened and went over to children to stop the incident from happening. It was also reported that no incident report was issued
Continued on page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 06-CC-20231020082712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUR SAVIOR'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600175
VISIT DATE: 12/07/2023
NARRATIVE
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Page 2 of 3

about the incident and it was only verbally.

On 10/23/23 LPA conducted a visit and interviewed a few staff. Some staff were not present on that day. Therefore, LPA interviewed the unavailable staff on other dates. A total of 11 staff were interviewed. (Staff # 1, 2, 3, 4, 5, 6, 7, 8, 9,10, and 11). Ten random parents were also contacted of whom two parents responded with positive feedback. Seven children were attempted to be interviewed but not successful. Children were not qualified for interviews due to their young age.

During interviewing eleven staff, LPA found out that only 5 staff were present during the occurrence of this incident on the playground. (Staff # 1, 2, 3,4, and 5) with 20 children. Staff were responsible for their own group on the playground. Staff # 1 and staff # 2 were responsible for the group of 10 children when the incident happened between two children).

Staff # 1 stated they were on the playground with staff # 2 responsible for their own group of 10 children. Staff # 1 was notified by staff # 2 while staff # 1 was busy with 3 children using the children’s restroom. The restroom is located on the outdoor space at the same level as the playground. Staff # 1 stated after being notified by staff # 2, staff # 1 went towards children who were engaged in inappropriate touching. Staff # 2 stated she observed child # 1 was crying. Staff # 2 called staff # 1 for help. Staff # 3 stated she was present on the playground but did not witness the incident as she was engaged in a conversation with a parent at the gate, but she heard about it. Staff # 4 stated she witnessed a shocking reaction from staff # 1 running towards two children. Staff # 4 observed inappropriate touching between child # 1 and child # 2. Staff # 5 stated she did not observe the incident but heard staff # 1 running towards two children. The rest of the staff stated they were not present and did not witness the incident when it happened. They only heard about it later. Staff # 1 stated she notified the two children's representatives verbally and not in writing. However, the facility failed to report such an unusual incident to the Department within 24 hours of occurrence as they are required to.

Based on interviews conducted with 11 staff, 10 parents of whom 2 responded with positive feed back, 7 attempted interviews with children, and reviewing documents, it was determined the preponderance of
Continued on page 3
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 06-CC-20231020082712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUR SAVIOR'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600175
VISIT DATE: 12/07/2023
NARRATIVE
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Page 3 of 3

evidence standard has been met, the allegations of "staff did not prevent child from being touched inappropriately by another child while in care" and "staff did not ensure reporting requirements were followed "are found to be SUBSTANTIATED.

Type A under California Title 22 Regulations Section 101229(a) Responsibility for care and supervision is cited on 9099D next page.

Type B citation under California Title 22 Regulations Section 101212(d) reporting requirements is cited on LIC9099D.

Amy Rivas was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
LPA Malek informed the director, Amy Rivas that this report dated 12/7/2023 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care. Also, LPA Malek informed the director, Amy Rivas to provide a copy of this licensing report dated 12/7/2023 that documents any Type A citation 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 from the date of this report.
A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The director, Amy Rivas, was provided with a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

The exit interview was conducted with director, Amy Rivas.

End of reports
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 06-CC-20231020082712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OUR SAVIOR'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600175
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/08/2023
Section Cited
CCR
101229(a)
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101229(a) Responsibility for Care and Supervision- The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by interviewing witnesses that the facility failed to provide adequate supervision to intervene in a timely manner to
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The director agreed to send a statement with the staff’s names and signatures acknowledging the section on the Responsibility for Care and Supervision of children. The proof of correction will be sent to LPA's email address by the due date of 12/8/2023
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prevent two children from being touched inappropriately while in care. Staff did not intervene in a timely manner to prevent the occurrence of the incident between the two 3-year-old children on the playground. This is an immediate risk to the health and safety of children in care.
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The director will follow up with staff watch the videos regarding supervision of children at the Department's website of: https://ccld.childcarevideos.org/child-care-center-operators/childrens-supervision-in-child-care The proof of watching the videos will be sent to LPA by 12/15/23
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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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 06-CC-20231020082712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: OUR SAVIOR'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600175
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2023
Section Cited
CCR
101212(d)
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Reporting Requirement- Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.................
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The director agreed to send a written statement acknowledging this section of the regulation that she is aware to inform the Department of any unusual incidents occurring at the facility.
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This requirement was not met as evidenced by the facility failing to report an incident of inappropriate touching between two 3-year-old children on the playground. This is a potential risk to the health and safety of children in care.
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The statement will be sent to LPA by the due date of 12/11/2023
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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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2023 and conducted by Evaluator Mahnaz Malek
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20231020082712

FACILITY NAME:OUR SAVIOR'S LUTHERAN PRESCHOOLFACILITY NUMBER:
300600175
ADMINISTRATOR:RIVAS, AMYFACILITY TYPE:
850
ADDRESS:200 SAN PABLOTELEPHONE:
(949) 492-6165
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY:116CENSUS: 23DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Director, Amy RivasTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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2
3
4
5
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9
Staff did not ensure child was spoken to in an appropriate manner.
INVESTIGATION FINDINGS:
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Page 1 of 2

Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a follow up investigation regarding the above allegations. This is a follow up for the visits conducted on 10/23/2023. LPA met with the director, Amy Rivas. There was a total of 23 children with 4 staff in one classroom and on the two playgrounds.

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

Our office has received a complaint report regarding the above allegation. According to the report, staff # 2 yelled at child # 2 when found out children were engaged in inappropriate touching on the playground during outside time.
Continued on page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 06-CC-20231020082712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OUR SAVIOR'S LUTHERAN PRESCHOOL
FACILITY NUMBER: 300600175
VISIT DATE: 12/07/2023
NARRATIVE
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Page 2 of 2

On 10/23/23 LPA conducted a visit and interviewed few staff. Some staff were not present on that day. Therefore, LPA interviewed them on other dates. A total of 11 staff were interviewed. (Staff # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11).
Ten randomly parents were also contacted of whom two parents responded with positive feedback.
Seven children were attempted to be interviewed but not successful. Children were not qualified due to their young age.
During interviewing 11 staff, LPA found out that only 5 staff were present during the occurrence of this incident on the playground. (Staff # 1, 2, 3, 4, and 5 with 20 children). Each group had their own staff. Staff # 1 and staff # 2 were responsible for the group of 10 children when the incident happened).

Staff denied staff yelling at children. Staff did not confirm yelling at children during this incident or any other occasions. Staff # 1 stated she yelled to stop the children of occurring the incident by did not yell at children. Staff # 1 stated she took child # 1 and child # 2 inside the classroom and talked to children about the incident inside the classroom. There were no other witnesses around staff # 1 when talking to child # 2. Staff # 1 stated she calmed down child # 1 because of crying. Staff # 2 did not confirm yelling at children. The other two staff who were present on the playground during the incident did not hear staff yelling at children. Staff # 5 stated she observed staff # 1 yelling to stop the children of the incident. LPA interviewed 6 other staff. They did not acknowledge staff yelling at children.

Based on the interviews conducted with a total of 11 staff, 10 parents of whom 2 responded with positive feedback, and attempted interviews with 7 children, there is not enough proof or evidence to support the occurrence of the allegation. This agency has investigated the complaint alleging " Staff did not ensure child was spoken to in an appropriate manner."; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Notice of Site Visit was posted. The notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The director, Amy Rivas was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights.
Exit interview was conducted with director, Amy Rivas.
End of report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 7