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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606946
Report Date: 09/27/2023
Date Signed: 09/28/2023 08:15:54 AM


Document Has Been Signed on 09/28/2023 08:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:MORNINGSIDE PRESBYTERIAN CHURCH CHILDREN'S CENTERFACILITY NUMBER:
300606946
ADMINISTRATOR:HEIDI SHIKUMAFACILITY TYPE:
840
ADDRESS:1201 E. DOROTHY LANETELEPHONE:
(714) 441-1227
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:60CENSUS: 0DATE:
09/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Director Heidi ShikumaTIME COMPLETED:
12:15 PM
NARRATIVE
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On 9/27/23, Licensing Program Analyst (LPA) Anna Chan conducted an unannounced case management incident inspection in response to a self-reported Unusual Incident dated 9/22/2023. LPA met with Director Heidi Shikuma. There are no children at 8:45am and children will start arriving after 12:15pm from school (minimum day Wednesday).

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 9/22/2023 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported that on 9/21/23 Staff #1 (S1) had a medical emergency in the classroom, S1 was left alone, by herself, with 3 children in care at closing time around 5:40pm.

During today's inspection, LPA interviewed the director about the incident. LPA obtained a copy of the children and staff sign in and out for 9/21/23. LPA also obtained video footage of the incident. LPA did a record review for S1. Based on record review, S1 did not meet the qualifications to be a school-age teacher, therefore, it is determined that the facility was not in compliance.

In response to this incident, the Director stated that all staff will have CPR/First Aid training following this incident. As a plan of action, the facility now has two closing staff daily, one being a fully qualified teacher.

Based on record review a Type B violation is cited under the California Code of Regulations Title 22 Division 12 Chapter 1; 101516.2(b)(1) School-Age Child Care Center Teacher Qualifications and Duties. This is an immediate health and safety and personal rights risk to the children in care. See deficiency observed and cited on LIC 809D.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Anna Francesca ChanTELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/28/2023 08:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: MORNINGSIDE PRESBYTERIAN CHURCH CHILDREN'S CENTER
FACILITY NUMBER: 300606946

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101516.2(b)(1)

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School-Age Child Care Center Teacher Qualifications and Duties:
(b) As an alternative educational prerequisite, a school-age child care teacher may, pursuant to Health and Safety Code Section 1597.21,...
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Director stated that a Teachers Aide will be supervised by a qualified teacher at all times.
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(1) Health and Safety Code Section 1597.21(d) contains the alternative educational requirements that a teacher may meet.

This requirement is not met as evidenced by:
Based on record review, S1 did not meet the requirements to be a school-age teacher.
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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: Anna Francesca ChanTELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MORNINGSIDE PRESBYTERIAN CHURCH CHILDREN'S CENTER
FACILITY NUMBER: 300606946
VISIT DATE: 09/27/2023
NARRATIVE
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Exit interview was conducted. The Notice of Site Visit was posted. Director 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.

Appeal Rights and deficiencies were explained. Director Heidi Shikuma was provided a copy of 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 Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Anna Francesca ChanTELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023
LIC809 (FAS) - (06/04)
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