304370454-2-2-2022-06-CC-RLOZ-CBGUZB-20220209150116

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370454
Report Date: 02/02/2022
Date Signed: 02/02/2022 02:12:03 PM

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
11/15/2021 and conducted by Evaluator Nguyen K Tran

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20211115165614

FACILITY NAME:	CLUB J		FACILITY NUMBER:	304370454
ADMINISTRATOR:	MARTIN, AUDRA		FACILITY TYPE:	840
ADDRESS:	1 FEDERATION WAY, SUITE #200		TELEPHONE:	(949) 435-3400
CITY:	IRVINE	STATE: CA	ZIP CODE:	92603
CAPACITY:	75	CENSUS: 13	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Hilaria Duran, Office Manager		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff handled day care child in rough manner.
Staff yelled at day care child.

INVESTIGATION FINDINGS:

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On 02/02/2022, Licensing Program Analysts (LPA) Tran conducted an in-person investigation to deliver the findings regarding the allegations that staff handled day care child in rough manner, and staff yelled at day care child. LPA Tran met with Office Manager Hilaria Duran. The Covid-19 Emergency Response questionnaires were asked prior entering the facility. A tour of the facility was conducted, and a census was taken. Observed at the time of the investigation was a total of 13 school age childrend and 4 staff.
A review of the Facility Personnel Report Summary on 02/02/2022 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 11/15/2021, the Regional Office received a complaint with two allegations alleging staff handled day care child in rough manner, and staff yelled at day care child. Reporting Party (RP) reported staff aggressively and with harmful intent, grab a child by the arm and pull child away from a class while continuously yelled at child.
(Continue next page)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20211115165614

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: CLUB J	FACILITY NUMBER: 304370454
	VISIT DATE: 02/02/2022

NARRATIVE

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(Page 2 of Report)

During the course of investigation, LPA Tran interviewed 6 staff members, 4 children and 5 parents.

During the staff interviews, 6 out of 6 staff denied witnessing any staff yelling or pulling children’s arms roughly.

During children interviews, all 4 children denied witnessing any staff yelling or pulling children’s arms.

During parent interviews, all 5 interviewed parents shared no concern about the facility, instead, they are very happy with the service at the facility.

Based on the information gathered from LPA's interviews and observation on 11/18/21 and 01/26/22, there is insufficient evidence to corroborate the allegations regarding staff handled day care child in rough manner, and staff yelled at day care child. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged allegations regarding staff handled day care child in rough manner, and staff yelled at day care child did or did not occur; therefore, the allegations regarding staff handled day care child in rough manner, and staff yelled at day care child are UNSUBSTANTIATED.

Exit interview was conducted. The Notice of Site Visit was posted. Facility representative, Hilaria Duran was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.” This report LIC 9099 was provided to the facility representative. First level appeal is to Regional Manager, address is above on the report.

(End of Report)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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