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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370880
Report Date: 03/02/2022
Date Signed: 03/02/2022 12:08:38 PM

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
01/19/2022 and conducted by Evaluator Pat Rivas
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220119091937
FACILITY NAME:KIDDIE ACADEMY OF TUSTINFACILITY NUMBER:
304370880
ADMINISTRATOR:ESTRADA, ELAINAFACILITY TYPE:
830
ADDRESS:14501 NEWPORT AVENUETELEPHONE:
(714) 508-0005
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:36CENSUS: 6DATE:
03/02/2022
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Elaina Estrada, Director TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are not wearing masks
INVESTIGATION FINDINGS:
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On 03/02/22 Licensing Program Analyst (LPA) Patricia Rivas conducted an unannounced complaint investigation visit regarding the allegation stated above. LPA Rivas met with Director Estrada who took LPA on a tour of the facility. This facility consists of one infant classroom. The facility shares common areas and bathrooms, staff lounge, kitchen, storage with facility #304370879 which consists of Four Classrooms, The Toddlers Classroom is directly across from the Infant Classroom. There was a total of 6 infants with 2 staff present during walk through.

A review of the Facility Personnel Report Summary conducted on 03/02/22 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must

Continued on page 2
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
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 6
Control Number 06-CC-20220119091937
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: KIDDIE ACADEMY OF TUSTIN
FACILITY NUMBER: 304370880
VISIT DATE: 03/02/2022
NARRATIVE
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obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
On 01/19/22 the Orange County Child Care Office received a complaint alleging staff are not wearing masks at the day care. The reporting party (RP) stated not all the staff are consistently wearing masks at the day care. The mandate in effect when the complaint was received from California Department of Public Health is for all individuals age 2 and up to wear a face covering while indoors irrespective of vaccine status.

During the investigation LPA conducted interviews on 01/24/22 and 02/01/22 with 8 staff and 5 parents. All 5 parents did not disclose any concerns. All 8 of 8 staff interviewed stated children must wear masks indoors but not required when outdoors. Of the teachers interviewed 6 of 8 stated one teacher consistently does not wear a mask. They reported to have witnessed staff not wear a mask when passing each other in the hallway of the building, inside staff’s classroom. All 8 of 8 staff interviewed stated there is a mask wearing policy for staff which is to always wear masks when indoors and not required when outdoors. During the facility tour on 02/01/22 In facility building which houses License#304370879. Staff lounge is shared, staff bathrooms are shared, entry hallway is shared. LPA observed one staff inside classroom which is not fully enclosed but an open concept where wall is approximately three feet tall. LPA observed Staff in classroom without a mask. LPA observed Staff with what appeared to be a lunch bag and water bottle/white tumbler in Staff’s hands. LPA observed a surgical mask hanging from Staff's right wrist. Staff advised LPA that "I had it on, there is no one here. I drank coffee" LPA did not observe cup of coffee but observed a water bottle/white tumbler.
During today’s visit, at 9:15 LPA Rivas observed two staff in Kinder Classroom under license# 304370879 not wearing masks. The two staff from the Kinder Classroom were speaking to teachers across the hallway to two staff in the Pre K Classroom. The Kinder Classroom and PreK Classroom do not have a fully enclosed room. The entry/Arch Way has an approximately three foot wall.
Interview with Director Ms. Estrada states that teachers are allowed to drink water in their classrooms but need to eat in the staff lounge. Even though Staff do not provide care for the infant component, staff do share common areas, lounge, walk way, staff bathrooms and one central entry point.

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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 06-CC-20220119091937
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: KIDDIE ACADEMY OF TUSTIN
FACILITY NUMBER: 304370880
VISIT DATE: 03/02/2022
NARRATIVE
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Based on observations on 01/24/22 and 02/01/22 and 03/02/22 and interviews conducted with 8 staff members and 5 parents, the licensee failed to ensure children are to be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by 6 of 8 teachers interviewed stated one staff consistently did not wear a mask indoors. LPAs observation on 02/02/22 of one staff in Pre K Classroom not wearing a mask and on 03/02/22 LPAs observation of two staff not wearing a mask in Kinder Classroom. Therefore, the preponderance of evidence standard has been met, therefore the above allegation masks are not being worn at the day care is found to be substantiated. California Code of Regulations, Title 22, Division 12 & Chapter 1, Section 101223(a)(2) is being cited on the attached LIC 9099D.

Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA provided Director with PIN 21-29 CCP copy of the PIN which was in effect when complaint was received California Department of Public Health (CDPH) Guidance for the use of face mask

Exit interview conducted and report was reviewed with Director Estrada. Appeal Rights were explained, Director was provided a copy of her Appeal Rights and signature on this form acknowledges receipt of these rights. Director was informed all appeals must be in writing and received by the Regional Office within 15 business days.

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 06-CC-20220119091937
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: KIDDIE ACADEMY OF TUSTIN
FACILITY NUMBER: 304370880
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2022
Section Cited
CCR
101223(a)
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Personal Rights The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Director will retrain staff, will enforce mandate which may include up to providing written warnings. director to provide copy of training which clearly states enforcement procedure.
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Based on LPAs observations on 02/01/22 & 03/02/22 for a total of 3 staff not wearing masks and interviews conducted . current mandate by the CA Dept. of Public Health is for all individuals age 2 and up to wear a mask indoors. This poses a potential risk to the health and safety of children in care
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Type B
03/07/2022
Section Cited
HSC
1596.88(c)
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Denial, suspension or revocation of license, registration, or special permits; grounds
The department may deny an application for or suspend or revoke any license, registration, or special permit issued under this act upon any of the following grounds and in the manner provided in this act: This
requirement was not met as evidenced
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Director will provide LPA with plan of action that will including but not limited to; training, staff accountability, how information will be documented
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 by;On 02/01/22 & 03/02/22 Director did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, andsafety of persons in care, in that facility staff did not wear face coverings while in the facility, as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings issued June 18, 2020 and updated November 16, 2020, and an individual mask exception did not apply.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
01/19/2022 and conducted by Evaluator Pat Rivas
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20220119091937

FACILITY NAME:KIDDIE ACADEMY OF TUSTINFACILITY NUMBER:
304370880
ADMINISTRATOR:ESTRADA, ELAINAFACILITY TYPE:
830
ADDRESS:14501 NEWPORT AVENUETELEPHONE:
(714) 508-0005
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY:36CENSUS: 6DATE:
03/02/2022
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Elaina Estrada, Director TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Personal Rights- Staff are working While Sick
Reporting Requirements-Facility is not reporting positive cases
INVESTIGATION FINDINGS:
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On 03/02/22 Licensing Program Analyst (LPA) Patricia Rivas conducted an unannounced complaint investigation visit regarding the allegation stated above. LPA Rivas met with Director Estrada who took LPA on a tour of the facility. This facility consists of one infant classroom. The facility shares common areas and bathrooms, staff lounge, kitchen, storage with facility #304370879 which consists of Four Classrooms, The Toddlers Classroom is directly across from the Infant Classroom. There was a total of 6 infants with 2 staff present during walk through.

A review of the Facility Personnel Report Summary conducted on 03/02/22 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The investigation included, interview with staff, parents, review of facility files, including Unusual Incident Reports, Staff attendance Records.
In reference to the allegation staff are working while sick;
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 06-CC-20220119091937
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: KIDDIE ACADEMY OF TUSTIN
FACILITY NUMBER: 304370880
VISIT DATE: 03/02/2022
NARRATIVE
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During the investigation LPA conducted interviews on 01/24/22 and 02/01/22 with 8 staff and 5 parents. All 5 parents did not disclose any concerns. Of the 7 of 8 staff interviewed stated they did not observe any staff working while sick. All 8 of 8 staff interviewed denied working while sick. Director reported their procedures requires all staff to have their temperature taken upon entering the facility and she or her assistant observe staff for symptoms throughout the day. Director reports she has advised staff not to report to work if they are ill. LPA P Rivas could not corroborate this allegation.


In Reference to the allegation that facility is not reporting positive COVID 19 cases;

During the investigation LPA conducted interviews on 01/24/22 and 02/01/22 with 8 staff and 5 parents. All 5 parents did not disclose any concerns. Director reported she or her staff have submitted Unusual incident reports (UIR) for Covid-19 positive cases. It was noted during visit that the UIRS reported were incorrectly reported under license#304370879. Director provided corrected copies of Unusual incident reports for this facility. Even though the initial reports were not made under this license number, Reports were provided to CCL under the license number that shares the building, under a different Component. Based on the available information LPA could not corroborate this allegation.
Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Estrada. Appeal Rights were explained, Director was provided a copy of her Appeal Rights and signature on this form acknowledges receipt of these rights. Director was informed all appeals must be in writing and received by the Regional Office within 15 business days.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6