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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600328
Report Date: 08/05/2024
Date Signed: 08/05/2024 04:11:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/14/2024 and conducted by Evaluator Cindy Nguyen
COMPLAINT CONTROL NUMBER: 06-CC-20240614145208
FACILITY NAME:SHORELINE CHRISTIAN PRESCHOOLFACILITY NUMBER:
300600328
ADMINISTRATOR:TOSCANO, MELIDAFACILITY TYPE:
850
ADDRESS:10350 ELLIS AVENUETELEPHONE:
(714) 962-6886
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:240CENSUS: 56DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Director, Melida ToscanoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Day care child sustained unexplained broken elbow due to lack of supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cindy Nguyen conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 06/18/2024. LPA met with Director, Melida Toscano, who accompanied LPA on a tour of the facility. Census was taken as follow: 4 toddlers, 52 napping preschool children with 6 staff members. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

On 06/14/2024 a complaint was filed with the Department alleging that day care child sustained unexplained broken elbow due to lack of supervision. During the investigation, LPA Nguyen conducted 2 physical plant inspection, interviewed 4 staff members, 5 preschool children, reviewed video footage, one staff statement, parent handbook, and the incident report.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
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 4
Control Number 06-CC-20240614145208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SHORELINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300600328
VISIT DATE: 08/05/2024
NARRATIVE
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Page 9099C

Complainant stated a child suffered a broken elbow due to a fall and none of the staff observed how the child fell until the child cried.

Information obtained from staff interviews and staff statements showed that no staff observed the incident. Staff #5 (S5) stated staff was looking around watching the children when S5 saw Child #6 (C6) on the ground lying on their stomach and started to cry. Staff did not observe the fall or know what had happened, however, staff noticed when C6 sat up was holding their left arm. C6 appeared to have an injury, so S5 called Staff #4 (S4) over to help take care of C6 so that S5 could continue watching the rest of the kids. S4 stated that staff S4 was on the playground around 4:45pm when S5 called to assist with a child, who had fallen off the second step of the play structure. S4 observed that C6 had woodchips on and the way C6 was holding their left arm, it looked injured, and was crying. S4 brushed off some of the woodchips while talking to C6 to find out what hurt and what had happened. Friends on the playground confirmed C6 had fallen, no one had pushed them. S4 took the child to the office to apply ice, further observations, and notified the mother of the incident.

On 7/01/2024, LPA called ten parents requesting an interview. Two parents were reached. The parents interviewed did not express any concerns related to the allegation and did not provide any information that could corroborate the allegation. The rest of the parents did not respond to the Department’s request for an interview.

LPA interviewed five children. The children did not disclose any pertinent information regarding the allegation of this complaint.

During the inspection on 06/18/2024, LPA Nguyen reviewed video footage with Director, Melida Toscano and Facility Technician. Director stated C6 fell off the second step of the play structure. C6 was crying and S5 ran over to check on C6. S5 was positioned where staff could see most of the children, but didn’t see C6 fall, S5 went over within 4 seconds of the fall, 10 seconds later S4 came over to help the child and took the child to the office.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20240614145208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SHORELINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300600328
VISIT DATE: 08/05/2024
NARRATIVE
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Based on the information gathered from LPA’s interviews with 4 staff members, 5 preschool children, review of video footage, one staff statement, parent handbook, and the incident report, it has been determined that the staff didn't observe the incident. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Section 101229(a) Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D.

Exit interview was conducted with Director, Melida Toscano. Notice of Site Visit was posted during the visit. 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. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20240614145208
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SHORELINE CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300600328
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2024
Section Cited
CCR
101229(a)
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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement is not met as evidenced by:

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LPA received an agenda & list of signatures of the staff attended the supervision training including visual observation on 07/10/24.
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Based on interviews from the four staff, review a video footage, one staff statement, it was disclosed that staff did not observe how the injury occur, which poses a potential risk to the health and safety of 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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
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