304270683-9-8-2021-06-CC-ECOL-C6NV6X-20210908161015

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270683
Report Date: 09/08/2021
Date Signed: 09/08/2021 04:10:20 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:	MAOF CHILD CARE CENTER-SANTA ANA		FACILITY NUMBER:	304270683
ADMINISTRATOR:	JOSIE BARTOLO		FACILITY TYPE:	850
ADDRESS:	2033 WEST EDINGER STREET		TELEPHONE:	(714) 557-2686
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92704
CAPACITY:	50	CENSUS: 9	DATE:	09/08/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Director - Josie Bartolo		TIME COMPLETED:	04:25 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	On 09/08/2021 Licensing Program Analyst (LPA) Corral conducted a Case Management - Incident Inspection to investigate an Unusual Incident Report (UIR) which was self-reported to our office on 08/26/2021. Prior to entering the Facility LPA Corral reviewed the COVID-19 Questionnaire with Director, Josie Bartolo. Upon entry to the facility, LPA Corral met with Josie, where 9 preschool children were observed in care with 4 staff members providing care and supervision. Due to COVID 19 Guidelines, LPA Corral observed staff members wearing face masks, social distancing and following CDC and Dept of Public Health Guidelines. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on 09/07/2021 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. According to the self-report incident sent to our office, a 4-year-old child (C1) cried and said she was afraid to go to school, when C1 was questioned why, the Child responded that S1 hit her on the thigh. The UIR stated that C1 attended the Facility but discontinued care and recently returned after Summer. The UIR stated that C1 demonstrated to Mother how S1 hit her on the thigh. The UIR also stated that Director Josie spoke to the Child’s mother and wanted to ensure the Child’s safety in school. The UIR stated that Josie spoke to the Program Director Norma regarding the incident, and stated they would conduct an internal investigation. Per the UIR parents were informed that children in that classroom would be interviewed. According to the UIR C1 has remained in school. LPA Corral interviewed the child’s mother on 08/30/2021 to inquire about the reported incident. Mother stated C1 is doing good and is attending care. The details reported in the UIR were confirmed. Child informed mom that S1 was nice and they played ball together. Continue to Page 2.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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: MAOF CHILD CARE CENTER-SANTA ANA	FACILITY NUMBER: 304270683
	VISIT DATE: 09/08/2021

NARRATIVE

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During today’s inspection, LPA Corral interviewed Director Josie, the details of the incident were confirmed. Director did inform LPA Corral that the Facility conducted their own Investigation. Director stated that during their internal investigation she spoke with all the children from Classroom #2 which was 9 children, and 5 children from Classroom #1. Six Staff members were also interviewed regarding the incident. Copies of the Interviews the Facility conducted were provided to LPA Corral.

S1 and C1 were not available to be interviewed during today's inspection. Based on the information obtained by the interviews conducted LPA Corral is unable to determine if the Personal Rights of C1 were violated. Further interviews will be conducted.

LPA Corral conducted an Exit Interview with Director Josie Bartolo. The report was read, reviewed and discussed with Director. Appeal Rights were explained, Director was provided a copy of their Appeal Rights and signature on this form acknowledges receipt of these rights. Director was informed all appeals must be in writing and received by the Regional Office within 15 business days. Notice of Site Visit was provided and posted by Director. Director was informed the Notice of Site Visit must be posted for 30 consecutive days and failure to post will result in a Civil Penalty of $100.00.
End of Report.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Eileen Corral	TELEPHONE: (714) 743-8354
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC809 (FAS) - (06/04)

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