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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300611718
Report Date: 05/05/2021
Date Signed: 05/05/2021 01:23:39 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:ORANGE COAST COLLEGE EARLY CHILDHOOD LAB SCHOOLFACILITY NUMBER:
300611718
ADMINISTRATOR:SANTACRUZ, ROCHELLEFACILITY TYPE:
850
ADDRESS:2701 FAIRVIEW ROADTELEPHONE:
(714) 432-5517
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:70CENSUS: 52DATE:
05/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Kourtney Jones-CoordinatorTIME COMPLETED:
01:45 PM
NARRATIVE
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The purpose of this visit was to conduct a case management visit of the facility regarding an unusual incident that was reported to our office on 4/29/21 by the facility representative Kourtney Jones. According to the incident a five year old pre-k child was left unsupervised in the outdoor play area during transition from lunch to outdoor play time. It was noted that the child was unsupervised for no more than 15 minutes.

Licensing Program Analyst (LPA) Hawkins met with Kourtney Jones, ECC Coordinator and toured the facility. Census was taken. There were a total of 52 preschool children with 7 staff and 2 student teachers supervising in different rooms and on the playground. A review of staff records on this date indicates that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA interviewed two staff and one child regarding the incident. Based on the information gathered through interviews and records, it was confirmed that Staff #1 left Child #1 unsupervised on the side outdoor play area alone for a period up to 15 minutes. Staff reports that it was an oversight/ mistake that occurred during transitioning of the children. This poses an immediate health and safety risk to the children in care.
California Code of Regulations, Title 22, Division 12 Section 101229(a)(1), is being cited on the attached LIC 9099D.
This report cites a 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. Notice of Site Visit was posted during the visit. Coordinator was informed that the notice of site visit must be posted for 30 consecutive days.

***continued on page 2***

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2021
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: ORANGE COAST COLLEGE EARLY CHILDHOOD LAB SCHOOL
FACILITY NUMBER: 300611718
VISIT DATE: 05/05/2021
NARRATIVE
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***page 2***

Failure to post will result in civil penalties of $100. Coordinator 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. All appeals must be in writing and received by the licensing office within 15 business days.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2021
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: ORANGE COAST COLLEGE EARLY CHILDHOOD LAB SCHOOL
FACILITY NUMBER: 300611718
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2021
Section Cited

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101229(a)(1)Responsibility for Providing Care and Supervision:The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The requirement was not met as evidenced by teacher leaving child unsupervised on the playground for up to 15 minutes. This posses an immediate health and safety risk to the children in care.
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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: Sherene HawkinsTELEPHONE: (949) 466-1624
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3