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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300603522
Report Date: 04/06/2023
Date Signed: 04/06/2023 07:34:59 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
04/05/2023 and conducted by Evaluator Nguyen K Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230405111703
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: 31DATE:
04/06/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Rebekah Bay, Director TIME COMPLETED:
08:00 PM
ALLEGATION(S):
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Facility did not provide type A violation report to children's representatives.
INVESTIGATION FINDINGS:
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On 04/06/2023, Licensing Program Analysts (LPA) Tran and LPA Chan conducted a 10-Day Initial Investigation regarding allegation about facility did not report type A violation to children's representatives. LPAs met with Director Rebekah Bay and informed the Director about the allegation.

A toured the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 31 preschool children and 6 staff members.

A review of the Facility Personnel Report Summary on 04/06/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 04/05/2023, the Regional office received a complaint alleging, facility did not provide type A violation report to children's representatives.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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 3
Control Number 06-CC-20230405111703
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: 04/06/2023
NARRATIVE
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(Page 2 of Report)

During the investigation, LPAs conducted observation regarding posting requirement, interviewed facility's Director and reviewed 7 random children's files.

During observation, LPAs observed the Notice of Site Visit was posted, however, the LIC 809 and LIC 809D report from 03/29/2023 were not posted, in the facility's front entrance.

During interview, Director admitted that the LIC 809 and 809D were not posted. Director stated Director did not know that the facility was supposed to post LIC 809 for the type A violation, and facility had not provided the LIC 809 report regarding the type A violation to the parent and did not obtain LIC 9224 from children's representatives.

During record review, 7 out of 7 reviewed children's files, did not have the Acknowledgement of Receipt of Licensing Reports LIC 9224 on file.

Based on LPA’s observation of LIC 809 was not posted, interview with Director and record review of 7 children's files, the preponderance of evidence standard has been met, therefore the above allegation that facility did not provide type A violation report to children's representatives, is found to be SUBSTANTIATED.
California Health and Safety Code, Section 1596.8595 (a)(3) and 1596.8595 (c)(1) Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services, are being cited on the attached LIC9099D. A civil penalty was assessed for failure to comply with posting requirements.

Exit interview was conducted. 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. “The licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to the director. First level appeal is to Regional Manager, address is above on the report.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20230405111703
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: 04/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2023
Section Cited
HSC
1596.8595(a)(3)
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1596.8595 Posting licensing report by child care facility...(a) facility shall post...report...that results in a citation for a violation that, if not corrected, will create a direct and immediate risk for persons in care. (3) Failure to comply...shall result in an immediate civil penalty of one hundred dollars ($100).
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Director immediately posted the LIC 809 and LIC 809D from 03/29/2023 on facility's front entrance.
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This requirement is not met as evidenced by:
LPAs observed the LIC 809 and LIC 809D report from 03/29/2023 were not posted, in the facility's front entrance and Director admitted she did not know about posting requirements for the type A citation.
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Type B
04/10/2023
Section Cited
HSC
1596.8595(c)(1)
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1596.8595 (c)(1) A licensed child day care facility shall provide to the parents ...copies of any licensing report that documents any Type A citation...
This requirement is not met evidenced by:
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Director states that she will obtain LIC9224 from parents by 04/10/2023.
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Based on record review, 7 out of 7 reviewed children's files, did not have the Acknowledgement of Receipt of Licensing Reports LIC 9224 on file.
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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: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3