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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370868
Report Date: 04/03/2025
Date Signed: 04/03/2025 04:41:48 PM

Document Has Been Signed on 04/03/2025 04:41 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CHRIST CATHEDRAL ACADEMY PRE-SCHOOLFACILITY NUMBER:
304370868
ADMINISTRATOR/
DIRECTOR:		PATRICIA L. ABEYTAFACILITY TYPE:
850
ADDRESS:13280 CHAPMAN AVENUETELEPHONE:
(714) 663-2433
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 73DATE:
04/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Patricia Abeyta (Director)TIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vivian Trinh conducted an on-site inspection for a self reported incident on 3/3/2025. The Director, Patricia Abeyta, was informed of the purpose of the visit, and a tour of LPA around the center was completed. The census included 73 preschool children and 12 staff members.

A review of the Facility Personnel Report Summary conducted on today’s date 4/3/2025 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 3/4/2025, an Unusual Incident Report (UIR) was filed with the Department to self-report an incident that occurred on 3/3/2025. Child #1 (C1) got hurt by Child #2 (C2) on the playground.

During the investigation, LPA interviewed six (6) staff members, three (3) children, and three (3) parents, obtained a copy of the children's roster, LIC 500, C1’s incident report, facility roster, sign-in/out copy of the day of the incident, and the email notification from teacher to C1’s parents, UIR follow-ups from Director with C1’s and C2’s parents, and medical report for C1.

LPA interviewed six (6) staff members. All staff members stated that they did not witness the incident in which C2 kicked C1 at the playground. LPA interviewed three (3) parents. None of the parents had any concerns about the facility.

During the interview, child #1 stated that C1 got kicked by child #2. In addition, Child #2 (C2) stated that C2 kicked C1 while they were in the playground. LPA interviewed six (6) children, during the children interview, Child 4 (C4) stated C4 saw C2 kicked C1 at the playground while they were playing together, the other two (2) children stated they know it that C2 was playing really rough with other children at the playground.

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NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHRIST CATHEDRAL ACADEMY PRE-SCHOOL
FACILITY NUMBER: 304370868
VISIT DATE: 04/03/2025
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During the record review, the medical review revealed that C1 sustained injury from the incident.

Based on LPA interviews and record review, the following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: CCR 101229(a)(1) Responsibility for Providing Care & Supervision. Please refer to the attached 9099D for documentation of deficiencies.



LPA Vivian Trinh informed Director Patricia Abeyta that this licensing report dated 4/3/2025 documents 1 “Type A” citation. Type A citation must be posted for 30 consecutive days LPA Vivian Trinh further informed Director Patricia Abeyta that:
A copy of this licensing report must be provided to parents or guardians of all children currently enrolled by the next business day or by the next day the children are in care.
A copy of this report must be provided to the parents or guardians of all newly enrolled children for 12 months from the date of this report.
A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) form must be placed in the child's file for verification of receipt of the report. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

An exit interview was conducted. The Notice of Site Visit was posted for at least 30 consecutive days. Appeal Rights were explained.

The End of Report.

NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/03/2025 04:41 PM - It Cannot Be Edited


Created By: Vivian Trinh On 04/03/2025 at 02:14 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: CHRIST CATHEDRAL ACADEMY PRE-SCHOOL
FACILITY NUMBER: 304370868

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/03/2025
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care & Supervision: No child(ren) shall be left without the supervision of a teacher at any time.... Supervision shall include visual observation. This requirement is not met by:
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The Director will look to additional resources and will prensent at the staff meeting on April 17, 2025. Director will send the agenda to LPA by April 18, 2025.
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Based on observation, interviews, and medical records review, staff who were present at the playground did not provide adequate supervision: did not see/prevent C2 kicking C1, causing C1 to be injured. This poses a potential risk to the health, safety, and person rights 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.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Vivian Trinh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2025


LIC809 (FAS) - (06/04)
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