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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300614054
Report Date: 06/17/2024
Date Signed: 06/17/2024 03:35:26 PM

Document Has Been Signed on 06/17/2024 03:35 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:BEYOND BLINDNESSFACILITY NUMBER:
300614054
ADMINISTRATOR/
DIRECTOR:		CAGLE, MEREDITHFACILITY TYPE:
850
ADDRESS:18542 B. VANDERLIPTELEPHONE:
(714) 573-8888
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 9DATE:
06/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:01 AM
MET WITH:Director,Meredith Cagle TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Aiddee Nunez conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 6/10/2024. During today’s visit, LPA met with director Meredith Cagle. LPA took census in the preschool classroom and there were 9 preschool age children with 2 staff members and 2 volunteers.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 6/10/2024, a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 6/7/2024, Child#1 (C1) jumped off the swing and ended up falling on his left arm in the wood chips area located directly under the swings. Staff members gave C1 a cold pack and contacted Parent#1 (P1) immediately. P1 took C1 to the urgent care and C1 was treated for a fracture on the left arm.

On 6/13/2024, LPA interviewed P1 via telephone. P1 stated that C1 was on the swing and jumped off the swing. P1 believes C1 got the arm hooked on the chain of the swing before falling off. P1 stated P1 took C1 to the hospital and was diagnosis with a fracture on the left arm and C1 is in a full arm cast and will have the cast for six weeks. P1 stated staff notify P1 immediately via the app and a phone call.

On 6/17/2024, LPA Nunez interviewed 3 staff members. 2 staff members stated they did not witness the incident. Staff#3 (S3) stated S3 was in front of C1 when the incident happened. S3 stated C1 was on an open swing when C1 put the left arm out and twisted the arm when C1 jumped off the swing and landed hard on the wood chips. S3 stated S3 picked up C1 and took C1 to Staff#1(S1). S1 stated S1 put an ice pack on C1’s left arm and gave C1 comfort. S1 message P1 via the facility’s app. S1 stated after 3 minutes S1 noticed C1’s arm was swollen. S1 notify the manager and called P1 via telephone since P1 did not response through the facility’s app.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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 CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: BEYOND BLINDNESS
FACILITY NUMBER: 300614054
VISIT DATE: 06/17/2024
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On 6/17/2024, LPA Nunez tried to interview C1 but did not qualify for an interview.

Based on staff interviews, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the inspection.

Exit interview was conducted with director, Meredith Cagle. Notice of Site Visit was posted during the visit. The director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

End of Report

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Aiddee Nunez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024
LIC809 (FAS) - (06/04)
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