300603522-3-9-2023-06-CC-SGUZ-CPRUTM-20230309145212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300603522
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:52:26 PM

Document Has Been Signed on 03/09/2023 02:52 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	GRACE HARBOR CHURCH AND SCHOOL		FACILITY NUMBER:	300603522
ADMINISTRATOR:	REBEKAH BAY		FACILITY TYPE:	850
ADDRESS:	12881 NEWPORT AVENUE		TELEPHONE:	(714) 544-4431
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY: 78	TOTAL ENROLLED CHILDREN: 52	CENSUS: 47	DATE:	03/09/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Danielle Dizdul, admissions director		TIME COMPLETED:	10:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/09/2023 Licensing Program analysts (LPAs), Stella Gutierrez and Anna Chan made an unannounced visit to the facility for the purpose of a self reported incident that occurred at the facility on 03/03/2023. LPAs were met by Danielle Dizdul, admissions director who was explained for the reason for today's visit. The director Rebekah Bay arrived to the facility at 9:37 AM. LPA observed 05 preschool staff and 47 preschool age children upon arrival. A review of the Facility Personnel Report Summary conducted on 03/09/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The assistant director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The facility self reported an incident that occurred at the facility on 03/03/2023. It was reported that Staff#1 observed a child in the restroom without adult supervision at the facility on 03/03/3023 at 9:00 AM. During today's inspection LPAs observed the transition procedure at 9:00 AM -9:30 AM on the playground and interviewed 03 staff. On 03/09/2023 Staff #1 stated that during transition from the playground to the classroom that the facility staff uses an app called ProCare to account for each child during the transition. On 03/03/2023 at about 9:00 - 9:05 AM during the transition and head count using the app, Staff #1 stated that they noticed that the child was not present during the transition. Staff #1 stated that they started to search for the child and about after 1 minute Staff #1 observed the child in the restroom without an adult present when after seconds Staff #2 entered the restroom from the other side when Staff #1 revealed to Staff #2 that they observed that the child was in the restroom without adult supervision. Page 1 of 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GRACE HARBOR CHURCH AND SCHOOL	FACILITY NUMBER: 300603522
	VISIT DATE: 03/09/2023

NARRATIVE

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Staff #2 interviewed today stated that when they were going to get a paper towel from the restroom is when it was revealed by staff #1 that the child was alone in the restroom.

LPAs observed the restroom the be a jack n Jill restroom accessible from the facility lobby and the play yard. The director, Rebekah Bay was interviewed today and stated that the parents have access to the restroom from the lobby. The director stated that the transition procedure is when the children are called by ringing a bell and then name to face roll call. Each child is accounted for on a white board count by where the bell is rang on the play yard. The children are then accounted for when entering the classroom. The director stated that the restrooms are kept unlocked and accessible to the children in care while on the play yard. The LPAs observed the restroom leads to the lobby where the exit doors are from the facility.

During today's inspection observations and interviews it was revealed that a child was in the restroom without adult supervision for almost up to one minute at the facility. It was further reveled that the facility did not make sure that the restroom that leads to the exit of the facility was inaccessible to the children while on the playground. This poses a potential risk to the children in care.

Based on LPAs observations and interview the following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101229(a)(1), 1 Type B is being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with the Rebekah Bay, director. 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: 03/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/09/2023 02:52 PM - It Cannot Be Edited

Created By: Stella Gutierrez On 03/09/2023 at 12:03 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 03/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/09/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.	1 2 3 4 5 6 7	The director locked the restroom doors to make the restroom inaccessible to the children without adult supervision. The restrooms will be accessible with a key that will be provided to each staff at the facility. This citation will be cleared during today's inspection.
	8 9 10 11 12 13 14	During today's inspection it was revealed and observed that a child was without adult supervision on 03/03/3023 in the restroom at the facility. The restroom is a jack n Jill style restroom that is accessible by the children which leads to the exit of the facility and a busy street where cars speed limit is 45 MPH. This poses a potential risk of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Patricia Magana

LICENSING EVALUATOR NAME:

Stella Gutierrez

LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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