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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300602018
Report Date: 04/13/2023
Date Signed: 04/13/2023 10:02:36 AM

Unsubstantiated


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
02/06/2023 and conducted by Evaluator Romelia M Castanon
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230206095421
FACILITY NAME:CALVARY CHURCH CHRISTIAN PRESCHOOLFACILITY NUMBER:
300602018
ADMINISTRATOR:HOLLAND, TINAFACILITY TYPE:
850
ADDRESS:1010 N TUSTIN AVETELEPHONE:
(714) 973-1768
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:133CENSUS: 55DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Director Tina HollandTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff do not provide adequate supervision to the daycare children while in care.
INVESTIGATION FINDINGS:
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On 04/13/2023, Licensing Program Analyst (LPA) Romy Castanon made an unannounced visit to the facility for the purpose to deliver findings of a complaint that was received at the Orange County Regional Child Care Program Office. LPA met with Director Tina Holland and explained the reason for today’s visit. A tour of the facility playground was conducted and census was taken. Observed at the time of the visit was a total of 55 children and 10 staff members.
A review of the Facility Personnel Report Summary on 04/13/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 02/06/2023, the Regional Office received a complaint report alleging staff do not provide adequate supervision to the daycare children while in care. The complaint was submitted by the Orange County Social Services Agency by referral from the Santa Ana Police Department.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 06-CC-20230206095421
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: CALVARY CHURCH CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300602018
VISIT DATE: 04/13/2023
NARRATIVE
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(Page 2) A report was made to the police department regarding concerns for the subject child while at daycare. Subject child is a 3-year-old that does not speak English as their first language. As of 04/13/2023, LPA has not received report or response regarding request from police department.

The complaint states subject child sustained a new scratch on their left cheek on 02/03/2023 that prompted law enforcement to be contacted. Earlier that week, the child was also seen with a bruise on the forehead. Complaint states on 01/17/2023, the child was observed with a one-inch scratch on the right cheek. Complaint states concerns regarding subject child’s frequent injuries may be due to a supervision issue at the facility.

LPA conducted an initial visit on 02/10/2023 with LPA Ana Francesca Chan. LPA’s interviewed Director, three (3) staff members and five (5) children. 3 out of 3 staff members were able to provide the policies and procedures regarding supervision and reporting injuries. All staff were able to describe systematic planning while supervising the children on the playground, as well as, indoors. 3 out of 5 children were able to state they receive assistance from staff if they are injured. On 02/15/2023, LPA Castanon and LPA Chan interviewed 11 parents. 7 out of 11 parents disclosed positive experiences with the facility and its staff. Four parents did not return LPA’s call for interview. LPA’s also interviewed subject child’s parents on 02/15/2023. Parent stated facility has notified them verbally and in writing regarding past injuries. Parent stated they did not make facility aware of their concerns of an increase of injuries to subject child. Parent declined LPA’s offer to interview subject child. Subject child was withdrawn and not longer attends facility.

LPA’s reviewed facility injury reports and found two recent reports had been documented. One report described the incident on 02/01/2023, how the child was injured and sustained a bruise. The report coincides with bruise observed on child the first week of February referenced on the complaint. Second incident report dated 01/26/2023, detailed how the child sustained a scratch on their face. Facility also verbally informed parents of 01/17/2023 scratch that was mentioned in the complaint.

Based on LPA’s interviews conducted and record review, the allegation alleging staff do not provide adequate supervision to the daycare children while in care may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted with Director Tina Holland. 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 penalty of $100. Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. (End of Report)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC9099 (FAS) - (06/04)
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