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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600825
Report Date: 04/11/2024
Date Signed: 04/11/2024 03:25:07 PM

Document Has Been Signed on 04/11/2024 03:25 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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RED HILL EVANGELICAL LUTHERAN CHURCHFACILITY NUMBER:
300600825
ADMINISTRATOR/
DIRECTOR:
CAAMANO, ANNA MARIAFACILITY TYPE:
850
ADDRESS:13200 RED HILL AVENUETELEPHONE:
(714) 544-3132
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 103TOTAL ENROLLED CHILDREN: 103CENSUS: 64DATE:
04/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Director Anna CaamanoTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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(Page 1)
An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Giselle Lucero in response to a self reported incident dated 03/27/24. LPA met with Director Anna Caamano. Director took LPA on tour of the facility and census was taken in individual classrooms. The overall census observed was 64 preschool age children and 6 staff members during nap time.

A review of adult records 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 03/28/2024, a self reported Unusual Incident Report (UIR) was filed with the Licensing Office. The Facility reported Child #1 (C1) tripped on the stairs of the play structure, fell, and broke their left arm.

During the investigation, LPA obtained a copy of the children’s roster, reviewed C1’s file, obtained copies of the incident report, conducted a physical plant inspection of the playground, took pictures of the play structure where the incident occurred, and interviewed C1, Staff #1 (S1), and Parent #1 (P1).

S1 stated on 03/27/2024 at 4:50 PM, S1 was standing on one side of the playground and there was a child that was being picked up and S1 turned to look at the child leaving. Staff #2 (S2) was at the gate helping with sign out. S1 then heard a cry in distress and saw C1 sitting on the stairs of the play structure. S1 stated not witnessing the fall due to looking away when C1 fell. S1 stated C1 was walked over to a bench to sit down, and an ice pack was provided to C1. S1 stated C1’s arm looked swollen and purple/blue color and S1 asked C1 to wiggle their fingers, C1 could not wiggle their fingers. S1 then called P1 to notify of the incident and C1 was picked up by P1 around 5:20PM.

(continue to page 2)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: RED HILL EVANGELICAL LUTHERAN CHURCH
FACILITY NUMBER: 300600825
VISIT DATE: 04/11/2024
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(Page 2)
C1 stated they were playing on the playground, and they tripped on the stairs on the play structure, fell and their left arm really hurt. C1 stated crying after falling and S1 saw C1 crying and asked C1 what happened. C1 then stated ice was applied and told S1 and S2 to call P1.

On 04/11/2024 LPA interviewed P1, P1 stated being notified about C1’s injury around 5 PM. P1 was notified by the facility that C1 was on the playground and tripped and fell on their arm. P1 stated C1 was taken to the hospital where C1 was treated for a broken wrist. P1 had no concerns about the facility and stated the incident was an accident.

The information obtained collaborated with the information reported by the facility. Statements made by S1, C1, and P1 indicate that the incident was an accident. Reporting requirements were met. Based on LPA observations, interviews conducted, and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies cited during today's inspection.

Exit interview conducted with Director Anna Caamano. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Director’s signature on this form acknowledges receipt of the report (LIC 809). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

End of interview.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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