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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370444
Report Date: 07/21/2023
Date Signed: 07/21/2023 12:32:36 PM

Document Has Been Signed on 07/21/2023 12:32 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:OC KIDS CHILDCARE INC.- CAWTHONFACILITY NUMBER:
304370444
ADMINISTRATOR:DIAZ, AMYFACILITY TYPE:
850
ADDRESS:10160 DENNI STREETTELEPHONE:
(714) 484-7844
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 34DATE:
07/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Amy Diaz, DirectorTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Quinto conducted an unannounced case management visit due to a deficiency discovered during staff interview. Census was taken and LPA observed 34 preschool children and 5 staff members.

A review of the Facility Personnel Report Summary conducted today indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.



The director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

During a visit to the facility, interviews with staff members were conducted and revealed that, Staff #1(S1) left child #1 in the restroom alone for approximately 4-5 minutes on 4/13/2023. A staff member found child#1 unsupervised at the gate between the elementary school and the PreK classroom after returning from the restroom.

On 7/21/2023, LPA interviewed the director. According to the director, on 4/13/23 around 10am, a child was left alone at the gate outside between the elementary school and the PreK classroom for 2 minutes. Director stated another staff discovered a child was missing when doing a head count after returning to the classroom. Director stated was not aware of reporting to Licensing; however, it was reported to the Licensee.

There was no record of the facility reporting the incident to Licensing.

On 7/21/2023, LPA reviewed S1 file and reviewed the employment write up dated 4/20/2023.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: OC KIDS CHILDCARE INC.- CAWTHON
FACILITY NUMBER: 304370444
VISIT DATE: 07/21/2023
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Based on the interviews conducted with director and record review, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision; 101212(d)(1)(C) Reporting Requirement. The deficiency is being cited on the attached 809D.

This is a Type 'A' violation, 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. The licensee is to keep Acknowledgement Receipt (LIC9224) signed by parents in each child’s file.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights 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. Failure to post Type A Reports for 30 days will result in a civil penalty of $100.00.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 07/21/2023 12:32 PM - It Cannot Be Edited


Created By: Mila Quinto On 07/21/2023 at 11:27 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: OC KIDS CHILDCARE INC.- CAWTHON
FACILITY NUMBER: 304370444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/28/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision...(1)No child(ren) shall be left without the supervision of a teacher at any time...
This requirement is not met as evidenced by:
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A civil penalty of $500 was assessed today.
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Based on interviews and record review, Staff 1 left a child alone without supervision upon return from the restroom to the classroom.
This poses an immediate safety risk to 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:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2023 12:32 PM - It Cannot Be Edited


Created By: Mila Quinto On 07/21/2023 at 11:35 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: OC KIDS CHILDCARE INC.- CAWTHON
FACILITY NUMBER: 304370444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements
(d) Upon the occurrence...(d)(1)...a report shall be made to the Department...within the Department's next working day...(1) Events reported shall...(C)Any unusual incident...
This requirement is not met as evidenced by:
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The Director stated will review the Reporting Requirement regulations and will email LPA of plan of correction by due date.
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Based on interview conducted with Director, the facility failed to report an incident of child was left unsupervised on 4/13/23.
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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:Patricia Magana
LICENSING EVALUATOR NAME:Mila Quinto
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
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