300600222-10-30-2019-06-CC-PMAA-BJ6S68-20191122123530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600222
Report Date: 10/30/2019
Date Signed: 10/30/2019 11:22:00 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/12/2019 and conducted by Evaluator Jung Mi Han

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20190912132447

FACILITY NAME:	FOOTHILLS PRESCHOOL		FACILITY NUMBER:	300600222
ADMINISTRATOR:	CAREY, MARGARET		FACILITY TYPE:	850
ADDRESS:	19211 DODGE AVENUE		TELEPHONE:	(714) 573-7723
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	60	CENSUS: 44	DATE:	10/30/2019
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Margaret Carey		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility did not report incidents to all appropriate parties

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jungmi Han conducted an unannounced complaint visit to deliver the complaint results. On 9/12/19 a complaint was filed with the Licensing office. LPA met with Director Marci Carey. Census was taken in individual classrooms. The overall census observed was 6 preschool staff and 44 preschool children. 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 9/18/2019, LPA Han interviewed five staff including director, seven children, review records including children’s file, and staff’s file. During the interview, director stated she mailed unusual incident report to licensing office since she received a complaint email from child#9’s parents on 9/10/2019 about lack of supervision resulting in an inappropriate interaction between daycare children in February 2019. LPA Han received unusual incident report that has been mailed to licensing office on 9/11/2019 and email threads

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20190912132447

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: FOOTHILLS PRESCHOOL	FACILITY NUMBER: 300600222
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/30/2019 Section Cited CCR 101212(d)(1)(c)	1 2 3 4 5 6 7	101212 (d)(1)(c) Reporting Requirements(d)Upon the occurrence, during the operation of the child care center of any of the events...telepohone or fax...(1)Events reported...(C)Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Director stated she will report any unusual incident to the licensing office by telephone or fax within the Department's next working day and during its normal business hours. Director submited Proof of correction (LIC 9098).
	8 9 10 11 12 13 14	Based on record review and interview on 9/18/2019, director did not report unusual incident in Feb. 2019 to the Department by telephone or fax within the Department's next working day and during its normal business hours. This poses a potential Safety risk to the 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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20190912132447

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: FOOTHILLS PRESCHOOL	FACILITY NUMBER: 300600222
	VISIT DATE: 10/30/2019

NARRATIVE

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between child#9’s parents and director on 2/12/2019, 9/10/2019, 9/11/2019, 9/12/2019, and 9/13/2019 regarding inappropriate interaction between daycare children incident.

RP’s spouse reported incident with child#9 on 2/12/2019 by email to the school. RP met director and staff#1 at the director’s office for couple minutes regarding the incident that child#9 told parent at home. LPA interviewed staff#1 and director. Staff#1 and director stated RP couldn’t state exactly when it happened, where it happened, and how it happened. Director stated she was not sure that the incident required reporting to licensing office.

Based on gathered interviews, LPA determined facility was not in compliance with Reporting Requirement. The director failed to ensure to report any unusual incident that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by interview.

Therefore, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 3 Section 101212(d)(1)(C) . Please refer to attached 9099D for documentation of deficiencies.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) 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. Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.

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.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

LIC9099 (FAS) - (06/04)

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