<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840476
Report Date: 12/13/2023
Date Signed: 12/13/2023 12:50:07 PM

Document Has Been Signed on 12/13/2023 12:50 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEUSD ORTEGA PRESCHOOLFACILITY NUMBER:
334840476
ADMINISTRATOR:ADRIA GALARZAFACILITY TYPE:
850
ADDRESS:520 CHANEY STREETTELEPHONE:
(951) 253-7129
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 29TOTAL ENROLLED CHILDREN: 29CENSUS: 20DATE:
12/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Teacher Vickie FluellenTIME COMPLETED:
01:00 PM
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
On December 13, 2023 at 11:15 am, Licensing Program Analyst (LPA) Jessica Rubio arrived unannounced to the facility to conduct a case management visit due to an unusual incident report (UIR) that the facility self reported. The UIR reported an incident that occurred on 12/4/2023, involving child (C1) being left alone in the bathroom located in the classroom while the rest of the children and staff were outside on the playground. LPA met with Teacher Vickie Fluellen and informed her of the reason for the visit. During the visit, LPA conducted an interview with S1 and also spoke via telephone to Director Adria Galarza. The UIR and interview with S1 revealed that during the transition to the outside playground, S1 took C1 and another child to the bathroom. S1 explained she was helping other children with putting on their jackets when S1 observed one child exit the bathroom and S1 believed everyone was out of the bathroom. S1 closed the door and proceeded outside with the other children. Approximately 5 minutes later, S1 returned to the classroom and heard crying. S1 opened the door to the bathroom and saw C1 was left in the bathroom. The interview revealed it was approximately 5 minutes from when S1 went outside and returned to find C1. The facility did notify C1's authorized representatives of the incident. It was also revealed that since the incident occurred, the facility is now using name tags to account for all children and has added a white board to the outside of the door to the playground. LPA determined the facility is in violation of Title 22 Regulation Section 101229 (a)(1) Responsibility for Providing Care and Supervision. A citation will be issued.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Teacher Vickie Fluellen. A notice of site visit will be provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/13/2023 12:50 PM - It Cannot Be Edited


Created By: Jessica M Rubio On 12/13/2023 at 12:31 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: LEUSD ORTEGA PRESCHOOL
FACILITY NUMBER: 334840476

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
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...Supervision shall include visual observation. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility has implemented a new system using name tags to account for children and added a white board with the count of children outside. Director Adria Galarza also stated an Active Supervision training for S1 is scheduled for 12/18/2023. Director will provide proof of training to LPA by plan of correction due date.
8
9
10
11
12
13
14
Based on C1 being left unsupervised in the bathroom for approximately 5 minutes which poses a potential health, safety or personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Pauline Beschorner
LICENSING EVALUATOR NAME:Jessica M Rubio
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2