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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371517
Report Date: 03/28/2023
Date Signed: 03/28/2023 05:08:19 PM

Document Has Been Signed on 03/28/2023 05:08 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:INTERNATIONAL SCHOOL OF ORANGE COUNTYFACILITY NUMBER:
304371517
ADMINISTRATOR:TRAN, LANUYEN (LANA)FACILITY TYPE:
850
ADDRESS:1838 NORTH SHAFFER STREETTELEPHONE:
(714) 771-4710
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 29DATE:
03/28/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Director, Lana Tran TIME COMPLETED:
05:15 PM
NARRATIVE
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On 03/28/23, Licensing Program Analyst (LPA) Dianna Valdez Santana conducted an unannounced case management visit to deliver deficiencies noted. LPA was assisted by Director Lana Tran.

A review of staff records on this date indicated that not all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA discovered that individuals, Ophelie Minnigerode and Tiphaine Untalan do not have a background clearance with Community Care Licensing. LPA also discovered that individuals, Quynh Dang and Jazzlyn Moore have background clearance but have not been associated to the facility. During today's inspection there were a total of 29 preschool children and 11 staff members.

The Director stated, fingerprint clearance for Ophelie Minnigerode and Tiphaine Untalan was done on July 2022 and a letter from Dept. of Justice was received. However, Director did not verify with Community Care Licensing on status of clearance.

The facility will be cited for Criminal Record violation, Type A for Ophelie Minnigerode and Tiphaine Untalan, California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101170(e)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. See LIC 809D. A civil penalty of $500 has been assessed for: Ophelie Minnigerode and $500 has been assessed for Tiphaine Untalan.

The facility will be cited for Criminal Record violation, Type A for failure to associate, Quynh Dang and Jazzlyn Moore, California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101170(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 101170 (f). A civil penalty of $500 has been assessed for: Quynh Dang and $500 has been assessed for Jazzlyn Moore. See LIC 809D. Page 1 of 2

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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: INTERNATIONAL SCHOOL OF ORANGE COUNTY
FACILITY NUMBER: 304371517
VISIT DATE: 03/28/2023
NARRATIVE
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This report cites Type A violations 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 LIC 9224 to be kept in each child's file.

Exit interview was conducted with facility representative. 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. Type A Report must also be posted for 30 days. 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.

Page 2 of 2. End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/28/2023 05:08 PM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 03/28/2023 at 04:15 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: INTERNATIONAL SCHOOL OF ORANGE COUNTY
FACILITY NUMBER: 304371517

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
03/28/2023
Section Cited
CCR
101170(e)(1)

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101170(e) All individuals subject to a criminal record...shall prior to working, residing or volunteering in a licensed facility:
(1) Obtain a California clearance...as required by the Department .
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When hiring new staff, the Director will verify with CCL office prior to new hired staff to work in the facility and ensure there is clearance and maintain record in staff's file.
A civil penalty of $500 has been assessed for: Ophelie Minnigerode.
A civil penalty of $500 has been assessed for: Tiphaine Untalan..
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This requirement is not met as evidenced by:
Based on observation and interview, file review, staff Ophelie Minnigerode and Tiphaine Untalan did not have background clearance. This is an immediate safety risk to the the children in care.
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Staff with "PENDING" status cannot return to facility until overall status has been cleared eligible to work. Director will email signed LIC 9224 forms to LPA at dianna.valdezsantana@dss.ca.gov
Type A
03/28/2023
Section Cited
CCR101170(e)(2)

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101170(e) All individuals subject to a criminal record...shall prior to working, residing or volunteering in a licensed facility:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or
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When hiring new staff, the Director will submit required transfer forms to CCL and associate new hired staff prior to working in the facility and ensure there is clearance and maintain record in staff's file.Director will create a Guardian account.

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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:Thuy Ho
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023


LIC809 (FAS) - (06/04)
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