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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370719
Report Date: 09/09/2022
Date Signed: 09/09/2022 12:54:38 PM

Document Has Been Signed on 09/09/2022 12:54 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:LEARNING CTR.C.D. P.S./ BOYS & GIRLS OF H.V.FACILITY NUMBER:
304370719
ADMINISTRATOR:SUSAN BIXLERFACILITY TYPE:
850
ADDRESS:17565 LOS ALAMOS STREETTELEPHONE:
(714) 593-1524
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: 44DATE:
09/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Susan Bixler - DirectorTIME COMPLETED:
01:15 PM
NARRATIVE
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A case management inspection was conducted today by Licensing Program Analyst (LPAs), Odom and Castanon who met with the Director, Susan Bixler. A self-report incident by the facility was received at the regional office on 8/22/22 which stated on 8/19/22 at 11:00am, and 2:00pm Staff #2 (S2) reported that Staff #1 (S1) forcefully sat child #1 (C1) on their chair during lunch time and during nap time S1 placed there foot on top of C1’s body.

Census was taken today and there was a total of 44 preschool age children with a total of 8 staff members. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During this investigation, LPA interviewed 3 staff, and obtained a copy of the children roster, personnel report, and police report. From the interviews conducted it was discovered that on 8/19/22 during lunch time S2 observed S1 had raised their voice at C1 because C1 got up from the lunch table, then S1 placed their hands on C1 and forcefully sat C1 back on their seat. S2 disclosed during nap time S2 observed S1 pick up C1 and place them back on their cot and remove their shoe and place their foot on top of C1’s body. According to internal investigation and police report S1 disclosed that on the day of the incident they did raise their voice to C1 and they did placed their foot on top of C1’s body.

Based on the information gathered from the interviews conducted, and records reviewed. It was determined that C1’s personal rights were violated by S1.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation Personal Rights section 101223(a)(3) was issued today on the attached LIC 809D.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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: LEARNING CTR.C.D. P.S./ BOYS & GIRLS OF H.V.
FACILITY NUMBER: 304370719
VISIT DATE: 09/09/2022
NARRATIVE
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This report cites Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Director of Program Samantha Hour 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. Appeal rights provided and explained. The Director 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.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/09/2022 12:54 PM - It Cannot Be Edited


Created By: Carmen Odom On 09/09/2022 at 12:30 PM
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: LEARNING CTR.C.D. P.S./ BOYS & GIRLS OF H.V.
FACILITY NUMBER: 304370719

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2022
Section Cited
CCR
101223(a)(3)

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101223(a)(3) Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a... This requirement was not met as evidenced by:
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Director stated they conducted an internal investigation and terminated S1 on 8/25/22. They have also proivided training on personal rights, hands on training, what not to do to children. The director will submit a written statement with plan of correction to licensing department within 24 hours along with sign in sheet of staff training.
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Based on interviews and records obtained S1 raised their voice at C1 during lunch time and S1 placed their foot on top of C1's body during nap time. This is an immediate risk to the health and safety 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:Judy Hanson
LICENSING EVALUATOR NAME:Carmen Odom
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2022


LIC809 (FAS) - (06/04)
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