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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304313514
Report Date: 12/20/2022
Date Signed: 12/20/2022 11:54:28 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2022 and conducted by Evaluator Stacy Torrence
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20221017163645
FACILITY NAME:JOHNSTON, YUKARIFACILITY NUMBER:
304313514
ADMINISTRATOR:JOHNSTON, YUKARIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 230-9002
CITY:IRVINESTATE: CAZIP CODE:
92614
CAPACITY:14CENSUS: 6DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yukari Johnston, LIcenseeTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Licensee did not provide adequate supervision to day-care child.
INVESTIGATION FINDINGS:
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Allegation: Licensee did not provide adequate supervision to day-care child.
On 12/20/2022, Licensing Program Analyst (LPA) Stacy Torrence conducted an in-person inspection to deliver the finding regarding the above complaint allegation. LPA Torrence met with one of Licensee’s Assistant. Upon arrival, licensee was not present at the facility. Licensee arrived at the facility approximately 10 minutes later. During today’s visit, there were also two additional assistants present. There was a total of three children and three infants present. A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 06-CC-20221017163645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
VISIT DATE: 12/20/2022
NARRATIVE
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On 10/17/22, Licensing office received a complaint alleging Child #1 (C1), 4 years old, wandered away from the facility without the knowledge and supervision of an adult on 10/17/2022. C1 walked away unnoticed from the front door toward Springbrook Elementary. C1 ran approximately half of a mile before the child was stopped by a crossing guard. The neighbor who lives 3 houses down the street advised the police officer that C1 might be from licensee's daycare. While the police officer walked C1 back to the day care, Staff #1 (S1) ran toward them and embraced C1. The police officer visited the daycare and stated the living condition of the daycare were good. The police officer did not believe there was any neglect occurring other than the fact that C1 run approximately a half mile away. Until today, licensing office has not received any Unusual Incident Report from licensee reporting C1 was wandering away on 10/17/2022.

During the initial 10-day inspection dated 10/25/2022, licensee was not home. Licensee was out of town for a family emergency. LPA interviewed 2 staff members and confirmed the reporting party's statements regarding the incident were accurate. Staff #1 (S1) who was present during the incident day stated the following: It was 10/17/2022 at around 1:30pm, S1 was getting the children ready to nap. S1 had two children and one infant in the crib in the nap room. S3 was in the tv room with 4 children. C1 was not ready to sleep so S1 told C1 to go to the tv room with S3. C1 had to walk through the living room, passed the front door to get to the tv room. C1 took off running towards the tv room. S1 thought C1 was in the tv room with S3. When S1went to go get C1 from the tv room to take a nap, C1 was not in the tv room. S1 asked S3 about C1 and S3 stated S3 never saw C1 came in the tv room. S1 looked for C1 everywhere in the house including upstairs (off-limit area) and outside for about 5-10 minutes. S1 did not hear the C1 opened the door. S1 went outside twice to look for C1. The first time S1 didn’t find C1 and didn’t see anyone to ask. S1 went back outside the second time and started asking random people. S1 asked a lady outside and that's when the lady’s son told S1 he had C1. S1 stated C1 was about 5 houses down at one of the neighbor’s house. S1 stated the lady’s son called the police. Later, the police asked S1 to call the C1’s mom to inform her about C1 wandering away.
S2 stated S2 was not present when the incident occurred as S2 was taking an hour lunch break.
LPA was unable to interview S3 as S3 had moved back to Japan permanently.
Licensee was in Japan at time of the incident.


SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20221017163645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
VISIT DATE: 12/20/2022
NARRATIVE
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Based on the information obtained from S1’s disclosure and physical plant inspection, the facility staff failed to provide adequate supervision resulting in a daycare child wandering away from the facility. Until today, licensing office has not received any Unusual Incident Report from licensee reporting C1 was wandering away on 10/17/2022.

These requirements were not met as evidenced by S1’s disclosure. The preponderance of evidence standard has been met; therefore, allegations licensee did not provide adequate supervision to day-care child is found to be substantiated. California Code of Regulations, Title 22, Division 12 & Chapter 1, Article 6 Operation of a Family Child Care Home 102417(a) and Reporting Requirements 102416.2(b)(2) are being cited on the attached LIC9099D. $500 immediate civil penalty was also being assessed today for Absent of Supervision.



This report cites a Type A deficiency: the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

Exit interview was conducted. Notice of Site Visit was posted during the visit. Licensee 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. Licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

End of Report

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20221017163645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/21/2022
Section Cited
CCR
102417(a)
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102417(a) Operation of a Family Child Care Home. Licensee shall be present in the home and shall ensure that children in care are supervised at all times. This requirement is not met as evidence by:
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Per licensee, she will submit a written plan to prevent this type of incident from occurring at the facility again. Per licensee, the written plan will be submitted by POC date of 12/21/22.
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Based on S1's disclosure, C1 wandered away from the facility without the knowledge and supervision of an adult. C1 walked away unnoticed from the front door toward Springbrook Elementary. This pose an immediate risk to the health and safety of the children in care. An immediate $500 civil penalty is being assessed today.
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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: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20221017163645
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JOHNSTON, YUKARI
FACILITY NUMBER: 304313514
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2022
Section Cited
CCR
102416.2(b)(2)
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Reporting Requirement.The licensee shall report to the Department any of the events: Any child absence means any instance where a child in care is missing. For example, any child in care who wanders away from the Family Child Care Home, is lost during an outing, or does not return from school, shall be reported even if the child is later found safe. This requirement is not met as evidence by:
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Per licnsee, she will send in a written indicating how to prevent this from occurring again by POC due.
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 Based on LPA’s interview and record review, C1 wandered away from the daycare on 10/17/22 and licensee failed to report the incident to the Department. This pose a potential risk to the health of the children in care.
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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: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5