<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371198
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:46:13 PM

Document Has Been Signed on 05/24/2022 03:46 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:FIRST UNITED METHODIST CHURCHFACILITY NUMBER:
304371198
ADMINISTRATOR:CHERI PAYNEFACILITY TYPE:
850
ADDRESS:161 SOUTH ORANGETELEPHONE:
(714) 316-5933
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 43DATE:
05/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Cheri Payne - DirectorTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Carmen Odom conducted an unannounced case management inspection regarding a self-reported unusual incident that was reported to the department on 05/12/22. Upon arrival LPA Odom met with Director Cheri Payne. At 10:30am, LPA Odom observed 3 children in the Adventure Depo (kindergarten) classroom with one staff supervising; 12 children in the Glassell Station classroom (2 years old) with two staff supervising; 11 children in Conductor Corner classroom (3 years old) with two staff supervising; 12 children in Explore Express classroom (4 years old) with two staff supervising; and 5 toddlers in Chapman Junction classroom with one staff supervising.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 05/12/22 the facility self-reported that on 5/12/22 at 10:30am outside in the playground Staff #2 (S2) observed Child #1 (C1) run up to Child #2 (C2) and tell C2 that C1 wanted to tell C2 a secret. S2 told C1 “no secret”. S2 observed C1 and C2 move to a different area. S2 asked C2 what did C1 tell you, C2 told S2 that C1 wanted to talk about private parts, but C2 did not want to talk about private parts and ran away. S2 immediately reported the incident to Director (S1).

Continue to page 2.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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 2
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: FIRST UNITED METHODIST CHURCH
FACILITY NUMBER: 304371198
VISIT DATE: 05/24/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Page 2
During staff interviews, S2 stated on 5/12/22 during outdoor play they were supervising the children in at the play structure, C1 came running to C2 and C1 told C2, “come here I want to tell you a secret”. S2 told C1 we don’t tell secrets and C1 said just want to talk to C2, I’m not going to tell a secret. C1 went up the stairs of the play structure and C2 followed C1. S2 followed C1 and C2 and observed C1 and C2 talking for less than a minute on top of the play structure. C2 left the play structure and S2 called C2 and asked C2 what C1 wanted to talk about. C2 said, C1 wanted to talk about private parts, and S2 asked C2 if they did and C2 said no ran away from C1. S2 stated they are always supervising C1 since the first incident that occurred back in April 2022 and they are part of the supervision plan that was developed for C1 back on 4/19/22. S1 stated on 5/12/22 they reported their concern to CPS, CPS took the report, but they told S1 they will not refer the incident for an investigation. S1 notified C1 and C2’s parents regarding the incident. S1 had a meeting with C1’s parents regarding multiple incidents. S1 stated since 4/19/22 they developed a plan of supervision for C1 by assigning 3 staff to constantly watch C1 throughout the day. C1 remains in a very small classroom setting for close supervision and staff are always aware to supervise C1 .

During children’s interviews, C1 and C2 disclosed they are always supervised by the staff in class and out on the playground. C2 disclosed that C1 wanted to tell them a secret and C2 told C1 don’t want too. C2 stated, C1 always says don’t tell the teacher. C2 disclosed C1 and C3 are separated because they want to hide, and staff always tell them no hiding. C1 disclosed C1 and C3 are separated because of mischief.

The information obtained collaborated with the information reported by the Director. Statements made by staff and children, S2 was supervising C1 and C2 during the incident. C1 has an active supervision plan in the classroom and outside in the playground. Reporting requirement were met. Based on LPA observations, interviews which were conducted, and records/documentation reviewed, there is no evidence to support any violation of Title 22 regulations. No Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with director Cheri Payne. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Director 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. Director Cheri Payne was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2