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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370987
Report Date: 03/04/2021
Date Signed: 03/04/2021 10:09:19 AM



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
05/29/2020 and conducted by Evaluator Tina Nguyen
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20200529144422
FACILITY NAME:KIDDIE ACADEMY OF HUNTINGTON BEACHFACILITY NUMBER:
304370987
ADMINISTRATOR:CARREON, NICOLEFACILITY TYPE:
850
ADDRESS:19342 BEACH BLVDTELEPHONE:
(714) 968-0078
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:124CENSUS: 38DATE:
03/04/2021
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:School assitant director Amber LopezTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Lack of supervision resulting in inappropriate interactions between day-care children.
INVESTIGATION FINDINGS:
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On 03/04/2021, Licensing Program Analysts (LPAs) Tina Nguyen and Carmen Odom conducted a in person inspection to deliver the findings regarding the above complaint allegation. LPA Nguyen and LPA Odom met with School assitant director Amber Lopez. This complaint investigation was initiated on 06/01/2020 by LPA Eileen Corral and continue on 08/05/2020 by LPA Tina Nguyen. The Covid-19 Emergency Response questionnaires were asked. Director Nicole Carreon came after.
There was a total of 38 preschool children and 6 staffs. 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.
On 05/29/2020, Licensing office received a complaint alleging lack of supervision resulting in inappropriate interactions between day-care children.
During the course of the investigation, LPA Corrol and LPA Nguyen conducted telephone interviews with staffs, children, and parents regarding an incident which happened on 05/20/2020, where child #6 (C6) pulled subject child's (C1) pants down and touched the private area inappropriately.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
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-20200529144422
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 HUNTINGTON BEACH
FACILITY NUMBER: 304370987
VISIT DATE: 03/04/2021
NARRATIVE
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The complainant shared with LPA Corral and LPA Nguyen that the facility informed complainant that C6 pulled C1 pants and underwear down and touched C1. Complainant believed the incident occurred with C1 results from lack of supervision. Complainant confirmed that the facility representative contacted C1 parents to inform about the incident the next day after the incident occurred. LPA Nguyen conducted a telephone interview with subject child three different times, but C1 refused to disclose any information regarding the incident.
During the investigation, facility staff representative (S2) indicated that one of facility staff witnessed the incident and stopped the children right away. Per S2 the next morning after the incident occurred, S2 informed the parent of C1 about the incident. S1 also talked to parents of C6 involved in the incident and C6 was suspended for the rest of the week. Per S2, the incident occurred on 05/20/2020, S2 faxed the Unusual incident report LIC 624 to Licensing office on 05/21/2020.
LPA Nguyen conducted interview to 6 children, was able to qualify and interview 4 children. No disclosures were made by children to LPA Nguyen regarding the incident. All interviewed children disclosed they like going to the school.

After interviewing staff, LPA Nguyen learned that while staff #3 (S3) observed the two children, C1 and C6 on the top of the slide at the same time, S3 came next to the playset where she observed the inappropriate touching from C6 after C1’s pants and underwear had already been pulled down. S3 confirmed that they did not know when C6 pulled C1 pants and underwear down. No staff confirmed that they had witnessed or observed C6 pulled C1’s pants down. However, S3 did state she observed the second action which was the inappropriately touching.
On 10/12/2020, LPA Nguyen attempted to ask for the video footage for the incident; the S2 and S1 confirmed that the video was not available since the video record is just available for three days.

Based on the gathered information, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter 1, is being cited on the attached LIC9099D.

The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20200529144422
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 HUNTINGTON BEACH
FACILITY NUMBER: 304370987
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/04/2021
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision(a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time...Sections 101216.2(e)(1) and 101230(c)(1). This regulation is not met as evidenced by:
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The facility representative will send a written plan to explaining better supervision to LPA Nguyen by 03/04/2021. The facility Representative also will send a statement regarding to the meeting with all the staff that they are all aware of the care and supervision section 101229 Title 22 Regulations to CCL.
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Based on the incident report written and interview with staff it was founded that during the incident happened on 05/20/2020, no staff observed or witnessed child #6 pulled subject child’s pants and underwear down. However, staff did witness the second action which was inappropriately touching. Therefore, there were not adequate supervision for that incident. This poses an immediate health and safety risk to 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: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/29/2020 and conducted by Evaluator Tina Nguyen
COMPLAINT CONTROL NUMBER: 06-CC-20200529144422

FACILITY NAME:KIDDIE ACADEMY OF HUNTINGTON BEACHFACILITY NUMBER:
304370987
ADMINISTRATOR:CARREON, NICOLEFACILITY TYPE:
850
ADDRESS:19342 BEACH BLVDTELEPHONE:
(714) 968-0078
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY:124CENSUS: 38DATE:
03/04/2021
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:School assitant director Amber LopezTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
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9
Day-care child caused injury to another child in care.
INVESTIGATION FINDINGS:
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On 03/04/2021, Licensing Program Analysts (LPAs) Tina Nguyen and Carmen Odom conducted a in person inspection to deliver the findings regarding the above complaint allegation. LPA Nguyen and LPA Odom met with asstiant director Amber Lopez. This complaint investigation was initiated on 06/01/2020 by LPA Eileen Corral and continue on 08/05/2020 by LPA Tina Nguyen. The Covid-19 Emergency Response questionnaires were asked. There was a total of 38 preschool children. 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. Director Nicole Carreon came after.
On 05/29/2020, our office received a complaint, alleging Day-care child caused injury to another child in care.
LPA Corrol and LPA Nguyen conducted a telephone interview with staffs, children, and parents to obtain additional information. Staff members denied witnessing other daycare child caused injury to subject child (C1). LPA Nguyen conducted interview to 6 children, was able to qualify and interview 4 children. No disclosures were made by children to LPA Nguyen. All interviewed children disclosed they like going to this school.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20200529144422
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 HUNTINGTON BEACH
FACILITY NUMBER: 304370987
VISIT DATE: 03/04/2021
NARRATIVE
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The complainant shared with LPA Corral and LPA Nguyen that there were bruise on subject child’s back. The complainant stated the incident occurred on in the playground. Complainant believed that the incidents occurred with C1 resulted from lack of supervision. LPA Nguyen asked for the pictures of the bruise; however, no pictures were provided to LPA Nguyen. LPA Nguyen conducted a telephone interview with subject child three different times and was able to interview subject child on the third time, but subject child refused to disclose any information regarding the incident.

On 10/12/2020, LPA Nguyen ask for the video footage for the incident. S2 and S1 stated that the video is not available since the video is only available for three days.

LPA Nguyen also contacted nine parents by phone and was able to interview three parents. All three parents interviewed stated they like the facility and have no concerns with staff supervision. Interviewed parents also stated they did not have any other concerns or issues with the facility.

Based on the information gathered from LPAs' interviews, there is insufficient evidence to corroborate the allegation. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged day care child caused injury to another child in care did or did not occur, therefore the allegations are unsubstantiated.

Exit interview was conducted.

The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5