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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300607110
Report Date: 11/14/2024
Date Signed: 11/14/2024 10:15:27 AM

Document Has Been Signed on 11/14/2024 10:15 AM - 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LIBERTY CHRISTIAN PRESCHOOLFACILITY NUMBER:
300607110
ADMINISTRATOR/
DIRECTOR:		KEITH, REGINAFACILITY TYPE:
850
ADDRESS:7661 WARNER AVENUETELEPHONE:
(714) 841-3816
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 117TOTAL ENROLLED CHILDREN: 117CENSUS: 23DATE:
11/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Director, Regina KeithTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Cynthia Sun conducted an unannounced follow-up case management inspection in response to a self-report Unusual Incident dated 10/18/24. LPA met with Director, Regina Keith and informed purpose of today’s case management initiated on 10/24/24. Census was taken as follows: 4 staff supervising 23 preschool children in the playground.

A review of staff criminal clearance 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 or exemptions.

On 10/18/24, Regional Office received a self-reported Unusual Incident Report (UIR) stating Child #1
(C1)’s arm at elbow was dislocated. On 10/16/24 Staff #2 (S2) stated Staff #1 (S1) was holding C1 hand and holding C1 to stand when C1 resisted and dropped body to the floor. C1 and C2 were sitting on the ground waiting to wash hands and started pushing each other. S1 moved C1 so C1 would not continue to be pushed by C2. On 10/18/24 at 9:02 AM C1 parents informed facility that C1 had nursemaids’ elbow, arm was relocated and C1 feels better. C1 is expected to be back to the program the week of 10/21/24.

On 10/24/24, LPA interviewed S1 who stated the following: On 10/16/24 S1 heard whining and saw C1 and C2 pushing each other. S1 asked C1 to move over. S1 asked C1 to stand. S1 reached out hand to help C1 get up. C1 got up and moved two kids over in the line. S1 stated child dropped body and moved over to sit on the ground.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LIBERTY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300607110
VISIT DATE: 11/14/2024
NARRATIVE
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LPA discussed the incident with the S1, the director and reviewed camera footage recording of incident. LPA observed C1 and C2 sitting on the ground next to each other. C1 and C2 began pushing each other back and forth. S1 approached C1, pointing to a space on the ground for C1. S1 standing next to C1, lifting C1 up by left arm with both hands guides C1 to sit down on the ground in a different space. C1 made a face of discomfort and C1 started crying. S1 walked away from C1. While C1 was sitting on the ground, C1 rubbed left arm and laid left arm on lap. S4 was singing a song with hand movement with the children while waiting for the children to wash hands and go get snack. S4 stated not seeing any children crying while waiting to wash hands and get snack. S4 stated remembering S1 later in the day stating C1 was crying about arm hurting. C1 lifted both arms and then laid and cradled left arm on lap. S4 motioned with hand for all children sitting on the ground to get up and follow S4. C1 stood up, started walking, moving right arm from side to side and left arm was observed hanging limp on side. LPA did not see C1 dropped self on the ground. C1 had returned to school. S4 stated S4 did not observe the incident between S1 and C1. On 10/24/24 LPA interviewed C1 and C2, but C1 and C2 did not qualify for interview. LPA interviewed Parent #1 (P1) who stated urgent care doctor informed parents’ C1 arm was dislocated, and doctor had to relocate C1 arm.
LPA reviewed the doctor note and confirmed C1 was seen for left arm pain and nursemaids’ elbow. Doctors note dated 10/17/24 stated: “your child has an injury called nursemaid’s elbow. Nursemaid’s elbow occurs when one of the bones in the forearm slips out of position at the elbow. It can happen during play or when an adult pulls a child up over a curb or other obstacle.”

Based on LPA’s interviews, record reviews, and video footage review, it was determined
preponderance of evidence standard has been met. S1 lifted C1’s hand up by left arm with both hands to guide C1 to sit down on the ground in a different space causing C1 to dislocate arm. Type A under California Title 22 Regulations Section 101223(a)(1) is being cited on the attached 809D.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LIBERTY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300607110
VISIT DATE: 11/14/2024
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Due to the Type A violation, the licensee 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. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

Exit interview conducted and report was reviewed with Director. Notice of Site Visit was posted and must remain posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights were explained. The Director was provided with a copy of the appeal rights (LIC 9058 01/16) 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.



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End of Report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Cynthia Sun
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/14/2024 10:15 AM - It Cannot Be Edited


Created By: Cynthia Sun On 11/14/2024 at 09:22 AM
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: LIBERTY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 300607110

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
101223(a)(1)

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101223 (a)(1) Personal Rights: The licensee shall ensure that each child is accorded
the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other
persons. This requirement is not met as
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Director will provide training for staff to get strategies to redirect children, and support staff to use other ways to keep children safe. Training will be completed and proof of training will be submitted to LPA by 11/27/24.
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evidence by: based on video footage review, S1 lifted C1’s hand up by left arm with both hands to guide C1 to sit down on the ground in a different space causing C1 to dislocate arm. This poses immediate risk to the health of the 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:Thuy Ho
LICENSING EVALUATOR NAME:Cynthia Sun
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
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