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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270866
Report Date: 07/19/2019
Date Signed: 07/19/2019 03:26:21 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:SALVATION ARMY, TUSTIN RANCH-CREATOR'S CORNER, THEFACILITY NUMBER:
304270866
ADMINISTRATOR:MITCHELL, CHRISTINEFACILITY TYPE:
850
ADDRESS:10200 PIONEER ROADTELEPHONE:
(714) 210-6040
CITY:TUSTINSTATE: CAZIP CODE:
92782
CAPACITY:112CENSUS: 59DATE:
07/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Christine MitchellTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Hawkins made an unannounced visit to the facility for a case management inspection to follow up on a self reported incident which happened on 5/14/19. Facility director reported that a parent reported to her that her child (child #1) reported to her that she was inappropriately touched by another child in her classroom and the time line of when and where the incident happened was unknown by parent. Director stated that after this information was reported by parent, the facility reviewed video footage of the previous two weeks immediately, and interviewed teaching staff who oversees the classroom where Child #1 attends.

LPA toured the facility inside and outside and observed 59 napping preschool children with 5 preschool staff in 6 classrooms (Room white, brown, red, blue, yellow, green). 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.

LPA reviewed records, inspected the facility, and interviewed three staff. Children identified as being involved were not interviewed due to there age and level of understanding.

LPA Hawkins was provided with a parent contact information for children involved, and additional supporting documents. Due to lack of information, LPA Hawkins will return to the facility at a future date to complete the investigation.

The facility is within compliance during today's inspection.

Exit interview conducted. 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 $100.00. Failure to post Type A reports for 30 days will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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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