304371614-12-6-2023-06-CC-PMAA-CYBME7-20231208083216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371614
Report Date: 12/06/2023
Date Signed: 12/06/2023 02:06:24 PM

Unsubstantiated

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
09/12/2023 and conducted by Evaluator Araceli Bootorabi

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20230912171307

FACILITY NAME:	PACIFIC ACADEMY		FACILITY NUMBER:	304371614
ADMINISTRATOR:	WEILI, LIN		FACILITY TYPE:	850
ADDRESS:	2987 MESA VERDE DRIVE E		TELEPHONE:	(833) 796-5688
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	60	CENSUS: 13	DATE:	12/06/2023
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Teresa Tseng		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff restrained daycare child

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) A. Bootorabi conducted an unannounced complaint investigation inspection on 12/06/2023. The purpose of today’s visit is for the delivery of findings.

Upon arrival, the LPA met with the Director, Teresa Tseng, and informed the purpose of today's visit.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, before initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The Department received a complaint on 09/12/2023 alleging staff restrained a daycare child.
LPA interviewed the Reporting Party on 09/19/2023. The reporting party mentions they briefly saw the incident alleged and are not familiar with staff or children enrolled in the program. The RP discloses that they witnessed S1 forcefully holding Child #1 (C1) while they were crying.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20230912171307

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: PACIFIC ACADEMY	FACILITY NUMBER: 304371614
	VISIT DATE: 12/06/2023

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

On 09/20/2023 LPA interviewed 4 staff members at the facility. LPA interviewed S1 on 09/20/2023, who denied allegation and denied ever witnessing any staff restraint a child. All staff interviewed denied restraining a child or witnessing S1 or any other staff restrain a child.

On 09/20/2023, LPA conducted interviews with 3 (C1-C3) children. 3 out of the three children interviewed on that date were assessed using a combination of color related questions and a truth/lie series. 1 of 3 children made no disclosures of personal rights being violated.

On 09/20/2023, LPA reached out to nine parents. Out of these nine parents contacted on that day, zero engaged in conversations with the LPA.

On 09/20/2023, LPA reviewed C1’s record for incident reports and communication logs. No record or specific date of this incident was available for review. There are no incident reports on file for alleged incident.

Based on LPA’s interviews conducted with the complainant, and 5 staff members. Based on Staff, and children interviews, there is not enough evidence to substantiate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

The Department received a complaint on 09/12/2023 alleging staff are not ensuring that the facility is free of vermin.
LPA visited the facility on 09/20/2023 and observed the classroom to be maintained in an orderly fashion. The kitchen was observed to be clean and organized. The LPA did not observe any vermin, or vermin droppings.

The LPA interviewed the Reporting Party (RP) on 09/19/2023. The RP mentions observing staff from the preschool facility not following sanitary food preparation procedures while preparing meals and having vermin on the premises.

Page 2

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20230912171307

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: PACIFIC ACADEMY	FACILITY NUMBER: 304371614
	VISIT DATE: 12/06/2023

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

S5 was interviewed on 12/6/2023 and they mention never seeing vermin in the kitchen. The pest control company informed the facility that they had captured vermin in their traps. S5 stated they increased the patrol and requested more traps in the suspicious areas.

On 09/20/2023, LPA reached out to nine parents. Out of these nine parents contacted on that day, zero engaged in conversations with LPA.

On 09/20/2023 the LPA received records of Pest Control invoices for 08/29/2023 6:48 am and services the facility received included the pest control setting up bait stations, Inspecting, performing preventative treatment. The pest control company made not further recommendations during the 8/29/2023 visit.
S3 mentioned that they come back every month to evaluate the facility.

The records indicated that the facility is actively working with the Pest Control company and any recommendations due to the vermin that was present on the facility premises.

Based on LPA’s interviews conducted with the complainant, and 5 staff members, LPA’s observations on 09/20/2023 there is not enough evidence to substantiate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Araceli Bootorabi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3