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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304371122
Report Date: 03/16/2021
Date Signed: 03/16/2021 01:41:14 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
07/09/2020 and conducted by Evaluator Jordann Nelson
COMPLAINT CONTROL NUMBER: 06-CC-20200709135610
FACILITY NAME:HILLSBOROUGH PRIVATE SCHOOLFACILITY NUMBER:
304371122
ADMINISTRATOR:SCHACHNER, BRITTANYFACILITY TYPE:
830
ADDRESS:191 OLD SPRINGS ROADTELEPHONE:
(714) 998-6031
CITY:ANAHEIMSTATE: CAZIP CODE:
92808
CAPACITY:33CENSUS: 8DATE:
03/16/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Carrie MercadoTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Staff used inappropriate diapering technique
INVESTIGATION FINDINGS:
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Tele-Inspection-COVID 19 State of Emergency
This is an amended report adding the ciatation section detail .
On 03/16/2021 Licensing Program Analyst (LPA) Jordann Nelson conducted an announced complaint Tele-Inspection regarding the allegation listed above with Carrie Mercado. The licensee was informed that due to COVID-19 and social distancing guidelines, the visit would be conducted via Facetime.
An allegation was received that a staff used inappropriate diapering technique with one children in care at the facility.

A review of staff records, child roster LIC 500 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. There were 8 children in care with 3 attending staff.

Continued on page 2.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021
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 3
Control Number 06-CC-20200709135610
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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304371122
VISIT DATE: 03/16/2021
NARRATIVE
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continued from page 1.

During the investigation LPA Nelson, interviewed three staff members including the, owner, director, and five parents. LPA Nelson reviewed and obtained the following: staff and children records. During the investigation, LPA Nelson reviewed staff personnel records, LIC 500 Personnel along with health and safety protocols the school is using.

Interviews were conducted with staff in regard to the diapering process all five parents did not have any concerns in regarding how diapering techniques were applied with their children. A parent did admit to providing adhesive and requesting that the medical tape be used to hold child’s diaper up while child naps. Interview with two teachers confirmed that they used the medical tape provided by the parent. The staff interviewed disclose that they did not feel comfortable using the medical tape, since it was part the child’s potty-training plan on record. Based on this inappropriate usage of medical, the child’s personal rights were violated by using the medical tape to hold the diaper up during nap time the allegation is substantiated.

Based on California Code of Regulations, Title 22, Division 12 Chapter 1 101223(a)(3) Child Personal Rights. The medical tape was used on the child as an added not allowing the infant to take the diaper off while they slept. Please refer to LIC 809-D. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. An exit interview was conducted a copy of this report was provided.

End of Report

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 06-CC-20200709135610
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: HILLSBOROUGH PRIVATE SCHOOL
FACILITY NUMBER: 304371122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2021
Section Cited
CCR
101223(a)(3)
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101223(a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including This was not met as evidence by…
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The director will conduct a training with the staff reviewing personal rights practices for all infants in care. The staff will ensure that no violations are used against any child or infant in care. The signed traning will be submitted to CCL by 03/30/2021.
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Based on interviews and record reviews. The staff used medical tape on the infants pamper to hold the diaper up. There was no tolielting plan in place or medical perscription by the pediatrician supporting this. Therefore this is a violations of the infants personal rights.
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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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann NelsonTELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3