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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371215
Report Date: 12/01/2021
Date Signed: 12/03/2021 02:06:50 PM

Document Has Been Signed on 12/03/2021 02:06 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:LEPORT-HUNTINGTON HARBORFACILITY NUMBER:
304371215
ADMINISTRATOR:ASGHAR, FATIMAFACILITY TYPE:
850
ADDRESS:16081 WAIKIKI LANETELEPHONE:
(714) 377-6035
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: 130DATE:
12/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Fatima Asghar - DirectorTIME COMPLETED:
04:30 PM
NARRATIVE
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A case management inspection was conducted today by Licensing Program Analyst (LPA), Carmen Odom who met with the Director, Fatima Asghar. A self-report incident by the facility was received by regional office on 11/18/21 which stated on 11/16/21 at 6:00pm, parent #1 (P1) complained that staff #1 (S1) grabbed child #1 (C1) hand causing C1 to cry, C1 did not have marks, bruises or redness on the hand.

Census was taken today and there was a total of 130 preschool age children with a total of 14 staff; A-1 classroom had 21 preschool children with 2 staff members, A-2 classroom had 17 preschool children with 2 staff members, A-5 classroom had 13 preschool children with 2 staff members, A-6 classroom had 21 children with 2 staff members, A-7 classroom had 19 preschool children with 2 staff members, A-8 classroom had 21 children with 2 staff members, and B-5 classroom had 21 children with 2 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 2 staff, 4 children and 1 parent. LPA also obtained a copy of the children roster, and personnel report. Throughout the interviews conducted it was disclosed that on 11/16/21 at 5:40pm, P1 heard C1 crying in a distinct manner than normal from across the courtyard of the preschool. As S1 took C1 to pick up C1s belonging, P1 asked C1 the reason for the crying, C1 did not respond, but S1 told P1 what happened in the classroom. S1 stated, at 5:35pm C1 was throwing blocks at another child, S1 told C1 not to throw blocks and that it was time to clean up when C1 began to cry. At 5:45pm, S1 dropped off C1 in the office, S1 told S2 why C1 was crying, after a few minutes C1 stopped crying and C1 was coloring at until 6:00pm. At 6:00pm, P1 picked up C1 in the office, C1 was whimpering quietly. P1 asked C1 outside the office what was the reason C1 continued to cry, C1 told P1 that S1 had helped C1s hand pick up the blocks, by squeezing hand hard. At 6:05pm, P1 spoke with S2 regarding the incident.

Continue to page 2.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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: LEPORT-HUNTINGTON HARBOR
FACILITY NUMBER: 304371215
VISIT DATE: 12/01/2021
NARRATIVE
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S2 removed C1 from classroom. During children’s interviews, C1 disclosed and demonstrated that S1 grabbed C1’s hand and squeezed four fingers hard because C1 did not want to clean up. Child #3 (C3) disclosed that S1 will hold children’s hands if they don’t listen, C3 demonstrated how S1 will hold children hand, by squeezing four fingers tight. Based on the information gathered from the interviews conducted, and records reviewed. It was determined that C1 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.

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 Fatima Asghar 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: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2021 04:12 PM - It Cannot Be Edited


Created By: Carmen Odom On 12/01/2021 at 03:26 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: LEPORT-HUNTINGTON HARBOR
FACILITY NUMBER: 304371215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2021
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, C1 was immediately removed from S1 care and the scheduled have also me adjusted to make sure C1 is not around S1. Another staff member is always with S1 to make sure S1 is not alone with children. Director will implement personal rights link into staff meeting notes on 12/2/21 and will submit staff acknowledgement signatures to LPA.
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Based on observations and interviews during today’s inspection: 2 children disclosed that S1 will hold childrens hand and squeeze fingers tight when children do not listen. This is an immediate risk to the personal rights to the children in care.
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Director will submit written plan of correction by 12/2/21.

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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: 12/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2021


LIC809 (FAS) - (06/04)
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