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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300605311
Report Date: 05/14/2021
Date Signed: 05/14/2021 12:47:25 PM

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:U.C.IRVINE-CHILDREN'S CENTERFACILITY NUMBER:
300605311
ADMINISTRATOR:TODINO, PAULAFACILITY TYPE:
850
ADDRESS:6533 ADOBE CIRCLE ROADTELEPHONE:
(949) 824-4752
CITY:IRVINESTATE: CAZIP CODE:
92617
CAPACITY:54CENSUS: 18DATE:
05/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Director, Paula TodinoTIME COMPLETED:
01:15 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
An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Cindy Nguyen in response to a self-reported incident dated 4/26/21. Present during today’s inspection was the Director, Paula Todina. Census was taken in individual classrooms. The overall census observed was 18 preschool age children and 4 preschool staff members. During today's inspection it was determined that the facility was operating within the licensed capacity and within compliance of staffing ratios. A review of adult records 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 04/27/2021 an Unusual Incident Report was filed with the Department to self-report an incident that occurred on 4/26/2021. Facility administrator called to report a child was able to exit the classroom into the playground unsupervised. The class was outside and was coming back inside to the classroom for lunch. Teachers completed a head count before children went back into the classroom and then again once children were inside the classroom. Staff #1 (S1) was passing out lunch to children while Staff #2 (S2) was assisting other children. After entering the classroom, the teachers did not close the door leading to the playground. Staff #3 (S3) from another classroom observed the child on the play yard and was approaching the child when S2 from the child’s class came out and found the child was picking flowers.

During today's inspection LPA interviewed 3 staff members and conducted a physical plant inspection. Based on the information gathered from the interviews conducted, statements from staff and a physical plant inspection. It was determined that the child was missing for approximately 1-2 minutes when Staff #2 found the child out in the yard by the fence of Extended Day with Staff #3.

Continued on Page LIC 809C
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
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 3
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: U.C.IRVINE-CHILDREN'S CENTER
FACILITY NUMBER: 300605311
VISIT DATE: 05/14/2021
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
Page LIC 809C

California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101229(a)(1)- Responsibility for Providing Care and Supervision is being cited on the attached LIC 809D.

This report cites Type A violation 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 LIC9224 to be kept in each child's file.

Exit interview was conducted with Director, Paula Todina . Notice of Site Visit was posted during the inspection. Facility representatives 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. Facility representatives 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.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: U.C.IRVINE-CHILDREN'S CENTER
FACILITY NUMBER: 300605311
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2021
Section Cited

1
2
3
4
5
6
7
101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on interviewed and self-reported unusual incident/injury report, child #1 was missing for approximately 1-2 minutes when the child’s teacher noticed. This poses and immediate health and safety 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
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 HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Cindy NguyenTELEPHONE: (714) 296-3608
LICENSING EVALUATOR SIGNATURE:
DATE: 05/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3