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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371215
Report Date: 07/25/2022
Date Signed: 07/25/2022 04:06:28 PM

Document Has Been Signed on 07/25/2022 04:06 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: 109DATE:
07/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Fatima Asghar, DirectorTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Mila Quinto conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 7/14/2022. LPA met with Director, Fatima Asghar. LPA observed 109 preschool children 14 staff in different classrooms.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 7/14/2022 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that a child was left in the playground without supervision for approximately 1 minute.

During today's inspection, LPA interviewed 2 staff members including the Director. According to the Director, on 7/13/22, Staff 2 informed Director that Child 1 was left alone in the playground during the transition time of returning to the classroom at 4:01pm. There were a total 2 staff and 14 children at the playground. As the children were lining up, the staff conducted a head count. Staff 2 lead the 14 children while Staff 3 was in the back of the line. Staff 2 realized Child 1 was not in line when they approached the front door of the classroom. Staff 2 immediately went back to the playground and called Child 1’s name. Child 1 came running from the bushes towards Staff 2. The interview with Staff 2 was consisted with the Director’s statement. Staff 3 was not interviewed as staff 3 is no longer at the facility.

Based on LPA’s interviews conducted with 2 staff members, 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. The deficiency is being cited on the attached 809D.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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: LEPORT-HUNTINGTON HARBOR
FACILITY NUMBER: 304371215
VISIT DATE: 07/25/2022
NARRATIVE
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If the facility receives a Type 'A' violation the licensee 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: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/25/2022 04:06 PM - It Cannot Be Edited


Created By: Mila Quinto On 07/25/2022 at 03:42 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: 07/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2022
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 as necessary to meet the children's needs. (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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The Director stated will install a white board on the playground to document the number of childre present. The Director also conducting an inperson meeting will all staff members on July 20 and July 21, 2022. The Director will provide a copy of the meeting agenda.
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Based on observations and interviews during today’s inspection, the 2 staff members stated Child 1 was left in the garden playground for approximately 1 minute without supervision.
This is an immediately 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: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


LIC809 (FAS) - (06/04)
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