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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371499
Report Date: 03/29/2023
Date Signed: 03/29/2023 09:47:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2023 and conducted by Evaluator Dean Thompson
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230307092921
FACILITY NAME:KIDDIE ACADEMY OF MISSION VIEJOFACILITY NUMBER:
304371499
ADMINISTRATOR:ESCOBEDO, CATHERINEFACILITY TYPE:
850
ADDRESS:25521 MUIRLANDS BLVD.TELEPHONE:
(949) 380-6868
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:120CENSUS: 44DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Catherine EscobedoTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Staff do not provide authorized representative with incident reports.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Thompson conducted an unannounced complaint investigation. This is a continuation of the investigation initiated on 3/10/2023. Upon arrival LPA met with Director Catherine Escobedo, to deliver complaint findings. Catherine Escobedo guided LPA on a tour of the facility. LPA observed a total of 44 Preschool age children with 9 staff.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the visit, it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

On 3/7/2023 a complaint was received alleging Staff do not provide authorized representative with incident reports.

Continue to Page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 06-CC-20230307092921
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KIDDIE ACADEMY OF MISSION VIEJO
FACILITY NUMBER: 304371499
VISIT DATE: 03/29/2023
NARRATIVE
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During the investigation LPA interviewed Director, reviewed children files, obtained the facility roster, obtained daily health checks, reviewed accident/injury reports and obtained page 23 of daily policies.

During the investigation, Director was interviewed on 3/10/2023. Director stated incident dated Tuesday, February 28, 2023 was verbally communicated to the parent of child (C1). Director stated, teacher did not write an incident report until the Friday, March 3, 2023 and the report was not physically provided to the parent of child (C1).

Director stated incident dated Friday, March 3, 2023 was verbally communicated to the parent of child (C1). Incident was written but was not physically given to the parent since the report was not written at time of pick up.



Kiddie Academy daily policies page 23 reads “Injuries are to be recorded on an Accident/Injury report by the employee who witnessed the accident.”

The Kiddie Academy Accident/Injury Report reads, This document MUST be completed immediately following an accident/injury. For an injured child, obtain the signature of a parent or legal guardian on the day of the injury.

Based on LPA interview with Director who stated Accident/Injury reports were not physically given to the parent of Child (C1) and copies of Accident/Injury reports with the director and parent signature missing the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter 12, is being cited on the attached LIC 9099 D for the deficiency section 101218.1(a)(B) Admission Procedures and Parental and Authorized Representative's Rights

Exit interview conducted and report was reviewed with the Director Catherine Escobedo. A notice of site visit was given and must remain posted for 30 days.



Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20230307092921
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KIDDIE ACADEMY OF MISSION VIEJO
FACILITY NUMBER: 304371499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2023
Section Cited
CCR
101218.1(a)(B)
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101218.1 Admission Procedures and Parental and Authorized Representative's Rights
(a) In accordance with the child care center's individual program, policies and needs, the licensee shall develop, implement and maintain an admission procedure that enables the person in charge of admissions to: (B) Provides the child's parent or authorized representative with information about the child care center that shall at least include the child care center's admission policies and procedures, activities, services, regulations, hours and days of operation, fees, procedures to be followed should the child become ill or injured while at the child care center, and procedures for conducting inspections for illness.

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Director will email LPA a written plan of correction outlining the procedures when completeing Accident/Injury Reports by POC due date.
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Based on LPA interview with Director who stated Accident/Injury reports were not physically given to the parent of Child (C1) and copies of Accident/Injury reports with the director and parent signatures missing.
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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.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
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