<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270866
Report Date: 08/01/2019
Date Signed: 08/01/2019 12:44:27 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: 65DATE:
08/01/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Christine MitchellTIME COMPLETED:
01:00 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
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. During todays inspection LPA toured the facility inside and outside and observed 65 preschool children with 10 preschool staff in 5 classrooms ( 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.

Based on reviewed records and interviews conducted, the director failed to report an unusual incident in a timely manner that occurred at the facility involving inappropriate touching between two children enrolled. This requirement was not met as evidenced by director reporting an unusual incident to the licensing office approximately 1 1/2 months after the incident occurred.

The facility was not in compliance and violation of the California Code of Regulations, Title 22, Division 12 Section 101212(d)(1)(C) was observed, discussed and cited at the time of the visit. (See LIC 809-D for specific deficiencies).



Exit interview conducted. An exit Interview was conducted. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.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: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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 2
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: SALVATION ARMY, TUSTIN RANCH-CREATOR'S CORNER, THE
FACILITY NUMBER: 304270866
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited
CCR
101212d(1)(c)
1
2
3
4
5
6
7
101212d(1)(c) Reporting Requirements:Each licensee or applicant shall furnish to the Department reports...Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by director reporting
1
2
3
4
5
6
7
The director will provide additional training in regards to reporting requirements regulations, submit a plan on how they will comply with the regulation, and provide a list of all staff who received training.
8
9
10
11
12
13
14
an unusual incident to the licensing office approximately 1 1/2 half months after the incident occurred.This poses a potential risk to the health and safety of child in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Sherene HawkinsTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2