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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304270968
Report Date: 01/24/2023
Date Signed: 01/24/2023 05:20:14 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
01/17/2023 and conducted by Evaluator Dianna ValdezSantana
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230117115541
FACILITY NAME:KATHERINE IRVINE DAY SCHOOLFACILITY NUMBER:
304270968
ADMINISTRATOR:ROSA DOMINGUEZFACILITY TYPE:
830
ADDRESS:1002 WEST 2ND STREETTELEPHONE:
(714) 541-8164
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY:16CENSUS: DATE:
01/24/2023
UNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Site Director, Rosa Dominguez TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility is malodorous.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Dianna Valdez Santana and Archibaldo Silva toured the facility inside and outside. Census was taken. The overall census observed was 7 infants and 4 staff supervising children in care. 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 January 17, 2023 a Complaint Report was filed with the Licensing Office. LPAs discussed the incident with Rosa Dominguez, director and site supervisor, Eva Hampton.
Reporting party stated it caused headaches and the cause could be a dead rat or mold from previous water leaks from the heavy rains. During the course of the inspection LPAs smelled a malodorous odor in room 6. LPA Silva exited and re-entered the classroom multiple times to check that the odor was not temporary. The odor persisted from the morning through the late afternoon hours. Page 1 of 2.



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
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-20230117115541
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: KATHERINE IRVINE DAY SCHOOL
FACILITY NUMBER: 304270968
VISIT DATE: 01/24/2023
NARRATIVE
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.Based on LPAs inspection of the facility, the following violation was observed is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101238(a), is being cited on the attached LIC 9099D.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

Page 2 of 2.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20230117115541
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: KATHERINE IRVINE DAY SCHOOL
FACILITY NUMBER: 304270968
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
CCR
101238(a)
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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times.

During the inspection, LPAs smelled a malodorous odor in room 6.
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Director stated, they will submit a priority work order for safety to the facilty and management team so that someone can come and inspect the building to trace the source of the smell. Director will email LPA proof of correction within two weeks
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LPA exited and re-entered the classroom multiple times. The odor persisted from the morning through the late afternoon hours.
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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: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3