300614019-11-15-2022-06-CC-CODM-CL7S3C-20221115123054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300614019
Report Date: 11/15/2022
Date Signed: 11/15/2022 12:31:02 PM

Document Has Been Signed on 11/15/2022 12:31 PM - It Cannot Be Edited

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:	BETHANY BIBLE FELLOWSHIP BETHANY CHRISTIAN PRE.		FACILITY NUMBER:	300614019
ADMINISTRATOR:	CARRILLO, AUDRIANNA		FACILITY TYPE:	850
ADDRESS:	13431 EDWARDS STREET		TELEPHONE:	(714) 894-0144
CITY:	WESTMINISTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	102	CENSUS: 57	DATE:	11/15/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Audrianna Carrillo - Director		TIME COMPLETED:	12:50 PM

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A case management inspection was conducted today by Licensing Program Analyst (LPA), Odom who met with the Director, Audriana Carillo. A self-report incident by the facility was received by regional office on 11/04/22 which stated on 11/03/22 at 10:14 am, Child #1 (C1) was running up the steps of a play structure, fell and hit the edge of the step, in which, it caused an open wound on the outer left eye brow area. C1 was taken to ER for medical attention and received 5 stitches.

Census was taken today and there was a total of 57 preschool age children with a total of 6 staff. A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During this investigation, LPA interviewed 4 staff, and 1 child. LPA also obtained a copy of the children’s roster, personnel report, ouch report and took pictures of the outdoor play structure and C1. Through interviews conducted with children and staff, it was disclosed by all 4 staff that none of the staff that were present on the day of the incident did not observe how C1 fell and injured themselves on the play structure. Staff #1 (S1) stated they did not observe how C1 fell due to their back turned away from the play structure. Staff #4 (S4) stated they did not observe how C1 fell due to being on the other side of the playground. C1 disclosed none of the staff observed how C1 fell and they had to notify S1 that they had hurt themselves. Staff #3 stated they asked staff how C1 hurt themselves and none of the 3 staff had observed how C1 fell, C1 told S3 how they fell and hurt themselves. C1 was shown a picture of the play structure and C1 pointed to steps of the play structure where child fell.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation under lack of supervision section 101229(a)(1) was issued today on the attached LIC 809D.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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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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: BETHANY BIBLE FELLOWSHIP BETHANY CHRISTIAN PRE.	FACILITY NUMBER: 300614019
	VISIT DATE: 11/15/2022

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LPA Odom informed Director Audriana Carrillo that this report dated 11/15/22 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety of children in care.

Also, LPA Odom informed the Director Audriana Carrillo to provide a copy of this licensing report dated 11/15/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Audriana Carrillo. A notice of site visit was given and must remain posted for 30 days.

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.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/15/2022 12:31 PM - 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: BETHANY BIBLE FELLOWSHIP BETHANY CHRISTIAN PRE.	FACILITY NUMBER: 300614019
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/15/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/15/2022 Section Cited	1 2 3 4 5 6 7	Responsibility for providing care and supervision 101229(a) 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... Supervision shall include visual observation. This requirement has not been met:
	8 9 10 11 12 13 14	Based on interviews conducted with 4 staff and 1 child it was determined that none of the 3 staff that were supervising the children on the day of the incident observed how C1 fell and hurt themselves. This poses an immidiate risk to the health and safety of the childcare children.	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 Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC809 (FAS) - (06/04)

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