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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300605482
Report Date: 01/12/2021
Date Signed: 01/13/2021 10:47:24 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
11/23/2020 and conducted by Evaluator Dean Valencia
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20201123142857
FACILITY NAME:U.C.IRVINE - INFANT TODDLERFACILITY NUMBER:
300605482
ADMINISTRATOR:HOVELAND, TERESAFACILITY TYPE:
830
ADDRESS:533 CALIFORNIATELEPHONE:
(949) 824-4754
CITY:IRVINESTATE: CAZIP CODE:
92617
CAPACITY:72CENSUS: 15DATE:
01/12/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Teresa Hoveland, DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Outdoor Play space not free of hazards.
INVESTIGATION FINDINGS:
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*State of Emergency COVID-19 tele-investigation was conducted via Facetime.*
A complaint tele inspection was conducted at the facility by LPA Dean Valencia (LPA) to investigate the above allegation. LPA met with director Teresa Hoveland. During the tele inspection, LPA conducted a physical plant tele inspection and took census of children in care. LPA observed 15 infant/toddler children and 15 staff members. During today's inspection staffing and capacity ratios were being met. A review of staff criminal clearance records on this date indicates all facility residents, staff, or other individuals who require clearances or exemptions.

On 11/23/2020 a complaint was received alleging the outdoor play area was not free from hazards. This is a follow up inspection visits to inspection visit conducted on 11/25/2020 and 1/6/2021. LPA determined that on 11/23/20 on the morning of an incident in which a child #1 (see Confidential Names list LIC811), came in possession of a small bag of THC candy.
(continued on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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-20201123142857
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: U.C.IRVINE - INFANT TODDLER
FACILITY NUMBER: 300605482
VISIT DATE: 01/12/2021
NARRATIVE
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This bag most likely ended up in the outdoor play yard of the facility by either birds leaving the candy bag (there were pecking marks observed on the bag), and/or a maintenance person leaf blowing the morning of and dislodging the bag from bushes, trash, etc. LPA has made this determination on photos of the THC candy bag appearing to be old, dirty, and have several holes poked in the bag. In addition, based on the information LPA was able to obtain, the child did not consume this candy as a staff was nearby and able to remove the bag from the child. The director stated in interview that soon after the incident, they spoke with child #1’s parent who stated the child had a test indicating the child did not ingest the THC candy. This was also later confirmed by adult #2, child #1's parent. The morning of the incident, the outdoor play yard was not checked for any potential hazards as is normal practice by staff.

Based on the interviews with staff, parents, 3 separate physical plant tele-inspections, and review of facility records; all of which occurred during the course of the investigation, this allegation has been substantiated. This constitutes a violation of outdoor activity space Regulation 101238.2(d)(2).

Based on this gathered information, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Due to the circumstances of the substantiation of this allegation LPA has determined that this had led to a potential threat to the child/ren’s health and safety and therefore a Type B violation cited today. The Licensee was provided a copy of appeal rights and their signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20201123142857
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: U.C.IRVINE - INFANT TODDLER
FACILITY NUMBER: 300605482
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2021
Section Cited
CCR
101238.2(d)(2)
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101238.2(d)(2) The surface of the outdoor activity space shall be maintained:
Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This was not met as evidenced by:
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The director has stated to LPA that the facility has begun implementing 2 a day outdoor play yard checks in response to this incident. Both in the morning and during naptime the outdoor play yard is checked, and a staff checks off a written checklist confirming the check. A copy of this checklist has been submitted to LPA.
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The morning on the day of an incident in which a child in care came in possession of a THC candy, although did not consume any of the candy, the outdoor play yard was not checked for any potential hazards. This is a potential threat to the children’s health and safety.
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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: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
LIC9099 (FAS) - (06/04)
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