300603950-11-9-2021-06-CC-JHAN-C8N33A-20211110165314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300603950
Report Date: 11/09/2021
Date Signed: 11/09/2021 11:50:35 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
11/01/2021 and conducted by Evaluator Dean Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20211101115057

FACILITY NAME:	HARBOR TRINITY PRESCHOOL		FACILITY NUMBER:	300603950
ADMINISTRATOR:	DAVIDSON, JENNIFER		FACILITY TYPE:	850
ADDRESS:	1230 BAKER ST		TELEPHONE:	(714) 556-4335
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	90	CENSUS: 53	DATE:	11/09/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Diane Dudley, Head Teacher		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Children are not encouraged to wear masks.
Staff are not wearing masks properly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dean Valencia conducted an unannounced complaint inspection on today's date, 11/9/2021. LPA met with head teacher Diane Dudley. At 10am the head teacher guided LPA on a tour of the facility and census of children was taken. At the time of the census LPA observed 53 children and 8 staff. On 11/9/2021 a complaint was filed with the Department alleging Children are not encouraged to wear masks, and Staff are not wearing masks properly.

During the course of the investigation, LPA interviewed the head teacher and 2 other staff, conducted a physical plant inspection of the classrooms. It was observed during the physical plant inspection of the classrooms that 2 of the 8 staff either not wearing a face covering at all or not wearing the face covering properly. Additionally, of the 53 children in care indoors, none were wearing a face covering. Based on the information gathered today by LPA, it was determined that the preponderance of evidence standard was met and the allegations are substantiated. The substantiated allegations constitute 2 seperate violations of Personal Rights, Title 22 Regulation section 101223(a)(2). (continued on LIC9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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-20211101115057

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: HARBOR TRINITY PRESCHOOL	FACILITY NUMBER: 300603950
	VISIT DATE: 11/09/2021

NARRATIVE

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(page 2)

The 2 B violations can be reviewed on the attached LIC9099D. Based on the LPA's gathered information, the preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA determined that the physical plant inspection and observing that 2 of the 8 staff in classrooms not wearing face covering correctly, and 0 of the 53 children ages 2 and above, not wearing face coverings at all is sufficient information to make the determination that these allegations are substantiated.

Based on LPA's observations the following violations were observed and are cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101223(a)(2). These 2 B violations are cited on the attached LIC9099D. There is a repeat violation being cited today. A previous violation of 101223(a)(2) was cited on 10/14/21 and a civil penalty was assessed today.

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. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the head teacher. LPA also provided head teacher with the PIN CCP 21-18, link to the most recent covid19 Guidance from CDPH, and a printed Title 22 Regulation section 101223 Personal Rights. All of these provided documents/link were reviewed and discussed with the head teacher.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20211101115057

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: HARBOR TRINITY PRESCHOOL	FACILITY NUMBER: 300603950
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/16/2021 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This was not met as evidenced by: Based on LPA's physical plant inspection	1 2 3 4 5 6 7	The head teacher stated they will discuss the violation with director when they return and will send out a notice to all staff to remind them of the CDPH covid19 Guidance, and face covering Guidance. Head teacher stated that staff will sign a form to be submitted to LPA, demonstrating that all staff in the facility understand, acknowledge, and will follow
	8 9 10 11 12 13 14	of the classrooms, it was observed that 2 of the 8 staff were either not wearing a face covering at all or not wearing the face covering properly. This constitutes a potential threat to the children's health, safety, and personal rights.	8 9 10 11 12 13 14	this Guidance. Proof of this will be submitted to LPA by 11/16/2021.
Type B 11/16/2021 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This was not met as evidenced by: Based on LPA's physical plant inspection	1 2 3 4 5 6 7	The head teacher stated they will discuss the violation with director when they return and will send out a notice to all parents to remind them of the CDPH covid19 Guidance, and face covering Guidance. Additionally to remind parents to bring face coverings for their children to be worn while indoors at the facility. Head teacher stated that this notice
	8 9 10 11 12 13 14	of the classrooms, it was observed that 0 of the 53 children were either not wearing a face covering at all. Based on this, LPA has determined children are not being encouraged to wear face coverings while in care indoors. This constitutes a potential threat to the children's health, safety, and personal rights.	8 9 10 11 12 13 14	and proof that parents were informed of the above items listed, will be submitted to LPA by 11/16/2021.

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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean Valencia	TELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC9099 (FAS) - (06/04)

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