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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313143
Report Date: 04/29/2019
Date Signed: 04/29/2019 10:43:31 AM

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:HORNYAK, MACHIKOFACILITY NUMBER:
304313143
ADMINISTRATOR:HORNYAK, MACHIKOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 843-9325
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:14CENSUS: 7DATE:
04/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Machiko Hornayk, Licensee TIME COMPLETED:
11:00 AM
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
A case management inspection was conducted by Licensing Program Analyst (LPA) Port. This is a continuation of the investigation initiated on 03/14/2019 in response to a self reported incident. Upon arrival LPA met with licensee, Machiko Hornyak who guided LPA on a tour of the facility. Upon arrival, LPA observed 7 preschool age children with licensee and Bruna Goncalvesdasilv. During today’s inspection it was determined that the facility was operating within compliance of staffing ratios and within its licensed capacity. Assistant, Saori Kameyama arrived at approximately 9:30 AM. Also present in an off limits room was Adult #1. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During the course of the investigation interviews were conducted with the licensee, Adult #1, Staff #1, Staff #2 and day care children. Third party agency reports were reviewed. In the interviews conducted Adult #1 admitted to talking to the children as a form of disciplining them. Adult #1 disclosed going to the children’s classroom and standing there and looking at them, to scare them. Adult #1’s disclosure demonstrates intent to scare children which is construed as intimidation of a child. Intimidation is a violation of a child’s personal rights. Based on the abridgment of personal rights, the following violation of the California Code of Regulations, Title 22; Division 12, Chapter 1, Article 6 was cited during today’s inspection: Personal Rights 102423(a)(4) (see LIC 809D). 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.

Inspection, report review and exit interview was conducted with licensee, Machiko Hornyak. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days, failure to post is subject to a civil penalty of $100. The licensee was provided a copy of appeal rights and her signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2019
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: HORNYAK, MACHIKO
FACILITY NUMBER: 304313143
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/30/2019
Section Cited

1
2
3
4
5
6
7
Personal Rights (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged...(4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions... This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on interviews conducted: Adult #1 disclosed going to the children’s classroom and standing there and looking at them, to scare them. Adult #1’s disclosure demonstrates intent to scare children which is construed as intimidation of a child. This poses an immediate personal rights risk to children in care.
8
9
10
11
12
13
14
A written statement acknowledging the video was viewed and understood will be sent to the licensing office by the due date of 04/30/2019.

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: Wendy PortTELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2