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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300603522
Report Date: 02/15/2023
Date Signed: 02/15/2023 01:00:44 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
02/08/2023 and conducted by Evaluator Stella Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230208113423
FACILITY NAME:GRACE HARBOR CHURCH AND SCHOOLFACILITY NUMBER:
300603522
ADMINISTRATOR:REBEKAH BAYFACILITY TYPE:
850
ADDRESS:12881 NEWPORT AVENUETELEPHONE:
(714) 544-4431
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:78CENSUS: 42DATE:
02/15/2023
UNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Rebekah Bay, directorTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Physical Plant -Facility does not provide a safe environment for children in care.
Physical Plant - Staff did not ensure that facility is free of trash.
Reporting requirements- Facility did not report physical plant changes of the play yard area of the addition of metal poles.
INVESTIGATION FINDINGS:
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On 02/15/2023 Licensing Program Analyst (LPA), Stella Gutierrez made an unannounced visit to the facility for the purpose of of complaint received on 02/08/2023. LPA was met by Rebekah Bay who was explained the reason for today’s visit. Census taken today, LPA observed 07 preschool staff and 42 preschool children in care.
A review of the Facility Personnel Report Summary conducted on 02/15/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 02/08/2023 a complaint was received alleging the allegations of Physical plant- That the facility does not provide a safe environment for children in care and the facility staff did not ensure that facility is free of trash.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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 4
Control Number 06-CC-20230208113423
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: GRACE HARBOR CHURCH AND SCHOOL
FACILITY NUMBER: 300603522
VISIT DATE: 02/15/2023
NARRATIVE
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On 02/08/2023 The reporting party stated the church had a member install poles for potential shading areas on the playground. These poles are not up to code and due to their location, they are a danger to our children and that they personally have witnessed children run into the poles. The reporting party stated that whomever installed them left cement droppings all over where 2,3 and 4-year-old children can access them as well as left trash everywhere. This is unacceptable and hopefully your facilities can assist this school/church in getting this building safe for our children.

On 02/10/2023 LPA, Gutierrez was able to interview the reporting party who stated that they observed large metal poles installed in the playground in round cement slabs and that there is cement and trash left on the play ground from the installation. The reporting party stated they wanted to recant the statement of seeing children run in to the poles but is afraid that will happen if something is not done as soon as possible.

On 02/15/2023 LPA conducted an investigation inspection regarding the alleged allegations. During the visit LPA was provided a full tour of the facility indoors and outdoors. LPA observed there to be 08 metal poles that were installed on the preschool playground over the play areas at the facility. 02 poles are within 5 feet of one of the buildings at the facility. The poles are metal and are about 11 feet above the ground in height. There was no padding materials observed to be around the poles installed. LPA did not observe any trash on the grounds during today’s inspection.

On 02/15/2023 LPA interviewed the director regarding the allegations. The director stated that the poles were installed on 02/04/2023 and did not know the about the poles until 02/06/2023. The director stated that there was also debris observed the morning of 02/06/2023 and it was immediately cleaned it up when observing the children throwing the debris.. The director further revealed that the change in physical plant of the addition to poles in the outside play area was not reported to their local licensing office.

During today, 02/15/2023 LPA took pictures of the poles installed and recommended to contact the contractor to get more information on how to ensure the safety for the children present of the new poles being properly installed. LPA received a copy of the installation contract.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20230208113423
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: GRACE HARBOR CHURCH AND SCHOOL
FACILITY NUMBER: 300603522
VISIT DATE: 02/15/2023
NARRATIVE
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Based on statements and observation, the allegations of physical plant- Facility does not provide a safe environment for children in care, the staff did not ensure that facility is free of trash and reporting requirements that the facility did not report physical plant changes of the play yard area addition of metal poles to their local licensing office is deemed substantiated. A substantiated finding means that the complaint is substantiated, and the allegations are valid because the preponderance of the evidence standards have been met. The following were revealed and are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Section 07 101238.2 Outdoor Activity Space and and 101237 (a) Alterations to Existing Buildings, 2 Type b deficiencies are being cited on the attached LIC 809D

Exit interview conducted and report was reviewed with the director, Rebekah Bay. Appeal Rights and deficiencies were discussed. The facility representative was provided 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.


A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20230208113423
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: GRACE HARBOR CHURCH AND SCHOOL
FACILITY NUMBER: 300603522
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2023
Section Cited
CCR
101238.2(d)(2)
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101238.2 Outdoor Activity Space(d) The surface of the outdoor activity space shall be maintained:
(1) In a safe condition for the activities planned.
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The director has since then removed the debris from the playground area. The director agrees as a plan of correction to order and place the cushioned material around the metal poles installed on the playground. The director is also going to provide pictures the that the padding was installed on all 8 poles via email to stella.gutierrez@dss.ca.gov
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This requirement was not meant as evidence by statements and obervations. During today's visit LPA observed no podding on the metal poles installed and the director stated that there was debris the children were throwing at each other. This poses a potential threat to the health and safety of children in care.
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Type B
02/16/2023
Section Cited
CCR
101237(a)
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101237(a) Alterations to Existing Buildings Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).
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Director agrees as plan of correction will submit a document in writing by 02/22/2023 to their local licensing agency via email to stella.gutierrez@dss.ca.gov of a report that the poles were installed correctly to ensure the safety of the children in care after the installation is complete.
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This requirement is not met as evidenced by:
Observation and statements that the director did not notify the department of adding the 08 metal poles and an order that they were properly installed. This poses a potential threat 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: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC9099 (FAS) - (06/04)
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