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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606476
Report Date: 05/17/2023
Date Signed: 05/17/2023 06:05:04 PM

Document Has Been Signed on 05/17/2023 06:05 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 SCHOOLFACILITY NUMBER:
300606476
ADMINISTRATOR:REBEKAH BAYFACILITY TYPE:
830
ADDRESS:12881 NEWPORT AVENUETELEPHONE:
(714) 544-4431
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 10DATE:
05/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Director Rebekah BayTIME COMPLETED:
06:30 PM
NARRATIVE
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On 05/17/2023, A case management inspection was conducted today by Licensing Program Analysts (LPAs), Chan and LPA Rivas who met with the Director, Rebekah Bay. A self-reported incident by the facility was received at the regional office on 05/11/2023 which stated that Child #1 (C1) had sustained burns and blister on left index finger.

Upon arrival there were 4 staff present and 10 infants in care. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Investigation consisted of interviews with staff, review of file, physical plant tour of infant rooms and observation of C1's left hand injury. LPAs interviewed Director, and 2 staff (S1 & S2) who were present at the time the incident happened on 05/11/2023. The following was found; S1 warmed up food for children’s lunches, while S2 changed diaper for the children. After S2 finished changing C1’s diaper, S2 placed C1 on the green highchair which was 8ft away from the microwave. S1 warmed up cheese cubes and egg for C1 for 30 seconds, and S1 stated she did not check the temperature of the cheese before placing it in front of C1. S1 stated she was trying to finish warming up everyone’s lunches. C1 began to pick the melted cheese with left fingers and cried. S2 picked up C1 when S2 saw what happened. S2 took out the melted cheese off from the fingers of C1, and S2 brought C1 to Staff #3 (S3). S3 applied first aid and Director was advised. Director contacted parents through procare and phone call about the incident. Director asked parents if they wanted to pick up C1 and parents stated to just keep themupdated. Director and S2 and S1 kept an eye on the child’s injury throughout the day, and update was communicated to the parents through procare. Child was picked up at the end of the day. C1 was taken to the urgent care and doctor diagnosed C1 with 2nd degree burn and provided a burns handout.



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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GRACE HARBOR CHURCH AND SCHOOL
FACILITY NUMBER: 300606476
VISIT DATE: 05/17/2023
NARRATIVE
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Based on the information gathered from the interviews conducted, observation of C1 injury, it is therefore deemed that the facility did not provide a safe, healthful and comfortable accommodations for the child.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation 101223(a)(2) Personal Rights was issued today on the attached LIC 809D.

LPAs Chan and Rivas informed Director Rebekah Bay that this report dated 05/17/2023 for Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Immediate Civil penalty was assessed during today’s visit.

Also, LPAs Chan and Rivas informed the Director Rebekah Bay to provide a copy of this licensing report dated 05/17/2023 Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Rebekah Bay. A notice of site visit was given and must remain posted for 30 days.



Appeal Rights and deficiencies were discussed. The Director Rebekah Bay 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.



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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2023 06:05 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 05/17/2023 at 04:48 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: 300606476

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2023
Section Cited
CCR
101223(a)(2)

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101223(a)(2) Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations...
This requirement is not met as evidenced by:
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Director stated that they did a staff training on burns and reviewed burns handout with the staff. Director also stated staff were trained on heating food. Director provided a copy of above training to LPA. Defeciency was cleared during this visit
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Based on LPA’s observation and interview, C1 sustained injury in the facility while in care. This is an immediate risk 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.
SUPERVISOR'S NAME:Rina Lopez
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023


LIC809 (FAS) - (06/04)
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