300603522-3-30-2023-06-CC-AFCN-CQETFS-20230330144200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300603522
Report Date: 03/29/2023
Date Signed: 03/30/2023 02:42:21 PM

Document Has Been Signed on 03/30/2023 02:42 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:	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: 78	CENSUS: 43	DATE:	03/29/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Director-Rebekah Bay		TIME COMPLETED:	06:30 PM

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 03/29/23, at around 8:30am, Licensing Program Analyst (LPAs) Nguyen Tran and Anna Chan conducted a case management inspection to follow up on a self-report unusual incident that was submitted to Community Care Licensing Regional Office on 03/22/23. LPAs met with Admissions Director Danielle Dizdul. LPAs informed Ms Dizdul of the purpose of the visit. During today's visit, a tour of the facility was conducted with Administrator. There were 43 preschool children and 6 staff in 5 different classrooms. Director Rebekah Bay arrived soon after. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. A self-reported incident was submitted by Rebekah Bay, Director, that on 03/22/23, at 4:10pm, The teachers were engaged with activities in the sanctuary. There were 32 children the sanctuary at the time of the incident with 4 teachers. There were 3 staff supervising children, while 1 of 4 staff will leave for a break. As children leaving for pick up, as Staff 1(S#1) cleaning up and saw Staff 2(S#2) taking Child 1 (C#1) back to the sanctuary through the church office. As S#2 was driving away from the parking lot, S#2 saw C#1 holding on to the office door as if he was getting ready to sneak out. S#2 went back to take C#1 back to the sanctuary and handed back to S#1. The church office door is usually locked, however the office staff left early, and door was not locked. The church office is located to the right side from the sanctuary and has a separate exit door leading to the parking lot. Staff informed child’s representative of the incident upon pick up. (Continue next page)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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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Document Has Been Signed on 03/30/2023 02:42 PM - It Cannot Be Edited

Created By: Anna Francesca Chan On 03/29/2023 at 04:03 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: 03/29/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/30/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) 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	Director provided a detailed plan to address the importance of providing supervison in care including supervision strategies, and ensuring all interior doors locked in sanctuary, while preschool children are on campus, and document of discussion with chuch admin staff to keep door closed and locked,
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: 2 of 3 staff who were present during the incident admitted absence of supervision for C#1 on 03/22/23 and LPAs observed C#2 left unsupervised in classroom #3 on 03/29/2023, this poses an immediate risk to health and safety of persons in care.	8 9 10 11 12 13 14	and kept all hazadous items in the office inaccessible for the children.
	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:

Rina Lopez

LICENSING EVALUATOR NAME:

Anna Francesca Chan

LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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: GRACE HARBOR CHURCH AND SCHOOL	FACILITY NUMBER: 300603522
	VISIT DATE: 03/29/2023

NARRATIVE

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(Page 3 of Report)

Due to the Type A violation cited today, the Director shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The Director is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the Director shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

Appeal Rights were explained. The Director was provided a copy of 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. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Rebekah Bay.

(End of Report)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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: GRACE HARBOR CHURCH AND SCHOOL	FACILITY NUMBER: 300603522
	VISIT DATE: 03/29/2023

NARRATIVE

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(Page 2 of Report)
During today's inspection, while LPAs conducting a tour through the facility, LPAs observed that classroom 3s are transitioning to go to the Great Room for music activity. LPA noticed Child 2 (C#2) left unsupervised in the classroom as the teachers had left the classroom with the other 12 children. Admission Director Dizdul, who were present during the tour, reminded Staff #5 (S#5) that S#5 must be always with the children. There was a total of 13 children, and 2 Staff members present at the time. LPAs also conducted inspection of the location of the incident. The church office is an off-limit area that has a door leading out to the facility parking lot, and another door connected to the Great room. There were 2 locks on the door that leads into the parking lot. In this office, there were a bottle of chemical on the shelves and 3 pairs of scissors on the staff’s desk which was accessible to the child on the day of the incident.

During interviews, LPAs interviewed 3 staff members. During the interviews, 2 of 3 staff who was present during the incident admitted absence of supervision for C#1 during indoor activity. When interviewed, S#2 stated that S#2 was leaving the facility, and upon going off shift in S#3’s own vehicle, S#3 observed C#1 with an opened church office door exit, which is an off-limit area, C#1 attempting to leave the facility without staff supervision. S#3 immediately parked vehicle and attended to C#1 and brought C#1 back in the Great Room through the church office door and informed C#1’s teacher about the incident. S#1 immediately informed the administration team about the incident.

Upon Record Review, LPAs reviewed staff and children roster on the day of the incident, and facility met staff to child ratio and within its licensed capacity on the date of the incident.

LPAs also obtained facility’s Parent Handbook, Teacher’s guide, facility roster and child’s file for further reviews.

Based on LPA’s observation of child#2 being left unsupervised in room #3 and inspection of the location where the incident occurred on 03/22/2023; interviews conducted with 4 staff and record reviews of children and staff roster, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision. This is a repeated violation that was previously cited on 03/09/2023. The deficiency is being cited on the attached 809D and an immediate civil penalty was assessed. (Continue next page)

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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