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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304270907
Report Date: 11/20/2024
Date Signed: 11/20/2024 11:20:50 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 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
10/22/2024 and conducted by Evaluator Anna Francesca Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20241022085950
FACILITY NAME:HILLSBOROUGH PRIVATE SCHOOLFACILITY NUMBER:
304270907
ADMINISTRATOR:STEPHANIE VERAFACILITY TYPE:
850
ADDRESS:4757 VALLEY VIEWTELEPHONE:
(714) 572-5696
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:97CENSUS: 9DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee Lacy BonnerTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Unqualified director
INVESTIGATION FINDINGS:
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On 11/20/2024, at 8:45am Licensing Program Analyst (LPA), Anna Chan conducted an unannounced Complaint investigation inspection to deliver findings of the investigation initiated on 10/25/2024. Upon arrival, LPA met with Director, Jay Ulibarri, LPA informed director of the purpose of visit and was led on a walkthrough of the facility and a census was taken. LPA observed 2 staff and 9 preschool children. Licensee Lacy Bonner arrived at around 9:20am to continue with the visit.

A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance.

The Department received a complaint on 10/22/2024 alleging unqualified director.

Page 1 of 2

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
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 5
Control Number 06-CC-20241022085950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304270907
VISIT DATE: 11/20/2024
NARRATIVE
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LPA interviewed director Jay Ulibarri, director stated they started in the facility 3 months ago.

On 10/25/24, LPA reviewed director’s file, based on records reviewed, director started 7/31/24. The director does not have Admin units at the time of inspection. The personnel records is incomplete and is missing documents required to qualify as a director. Documents missing are as follows: LIC503 Heath screening, immunization, record keeping orientation, 16hr health preventative with Lead, LIC308 designation or responsibility. The Department did not receive any exception request for not having admin units.

LPA interviewed parents, and none of the parents interviewed disclosed any information that support the allegation.

Based on interview and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. A substantiated finding means that the complaint is substantiated, and the allegations are valid. See LIC9099D for 2 Type B deficiencies.

An exit interview was conducted with Licensee, Lacy Bonner. Report and deficiencies were discussed. The Notice of Site Visit was posted during the visit. The licensee 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. The 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.

Page 2 of 2
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 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
10/22/2024 and conducted by Evaluator Anna Francesca Chan
COMPLAINT CONTROL NUMBER: 06-CC-20241022085950

FACILITY NAME:HILLSBOROUGH PRIVATE SCHOOLFACILITY NUMBER:
304270907
ADMINISTRATOR:STEPHANIE VERAFACILITY TYPE:
850
ADDRESS:4757 VALLEY VIEWTELEPHONE:
(714) 572-5696
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:97CENSUS: 9DATE:
11/20/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee, Lacy BonnerTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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9
Staff are discriminating against a child
INVESTIGATION FINDINGS:
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On 11/20/2024, at 8:45am Licensing Program Analyst (LPA), Anna Chan conducted an unannounced Complaint investigation inspection to deliver findings of the investigation initiated on 10/25/2024. Upon arrival, LPA met with Director, Jay Ulibarri, LPA informed director of the purpose of visit and was led on a walkthrough of the facility and a census was taken. LPA observed 2 staff and 9 preschool children. Licensee, Lacy Bonner arrived at around 9:20am to continue with the visit.

A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance.

The Department received a complaint on 10/22/2024 alleging staff are discriminating against a child.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20241022085950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304270907
VISIT DATE: 11/20/2024
NARRATIVE
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LPA interviewed staff at the facility. Staff interviewed stated they have not witnessed other staff discriminate children or violate personal rights.

LPA interviewed children, and none of the children interviewed disclosed any information that support the allegation.

LPA interviewed parents, and none of the parents interviewed disclosed any information that support the allegation.

Based on interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and report was reviewed with Licensee, Lacy Bonner. The Notice of Site Visit was posted during the visit. The licensee 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. The 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

Page 2 of 2
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20241022085950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304270907
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
101215.1(h)(1)(A)
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101215.1 Child Care Center Directors Qualifications and Duties - (h) Child care center directors shall have completed one of the following prior to employment: (1) High school graduation or GED...(A) Three of the 15 units required in (h)(1) above shall be in administration or staff relations.
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Licensee stated, they will send request for exception to LPA by due date of 12/20/24
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This requirement was not by as evidenced by:
Based on record review, the director has no admin units and there is no request for exception recevived by the Department.
This poses as a potential risk to health and safety of children in care
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Type B
12/20/2024
Section Cited
CCR
101217(a)
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101217(a) Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:... This requirement was not met as evidenced by
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Licensee stated, director will complete missing documents and a copy will be provided to LPA by due date of 12/20/24
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Based on record review, the director file is incomplete. Missing record keeping orientation, health screening, immuzation, 16-hr health preventative, designation of responsibility
This poses as a potential risk to 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.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5