304371198-4-19-2022-06-CC-NKTN-CDMUBR-20220419152646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371198
Report Date: 04/19/2022
Date Signed: 04/19/2022 03:27:00 PM

Document Has Been Signed on 04/19/2022 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	FIRST UNITED METHODIST CHURCH		FACILITY NUMBER:	304371198
ADMINISTRATOR:	CHERI PAYNE		FACILITY TYPE:	850
ADDRESS:	161 SOUTH ORANGE		TELEPHONE:	(714) 316-5933
CITY:	ORANGE	STATE: CA	ZIP CODE:	92866
CAPACITY:	60	CENSUS: 52	DATE:	04/19/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cheri Payne, Director		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Tran conducted a case management inspection to follow up on a self-report unusual incident that was submitted to Community Care Licensing Regional Office on 04/14/2022. It was reported by Cheri Payne, Director. According to tthe Director, on the evening of 04/10/2022 Child #1 (C1) told the parent at home that Child #2 (C2) asked C1 to show C1's private part, and C2 would pay C1 a dollar. C1 told the parent that C1 did not do it. C1's parent informed the Director and Director asked the teachers. No report from the teachers if any related interactions between C1 and C2. Director reported that they had experienced C1 and C2 exposing to each other in the past that teachers witnessed it. Director called Child Protective Service (CPS) on this past issue on 2/24/2022. CPS worker came to interview children and provided CAR on 4/1/22 stating the situation is stabilized and case is closed. Currently here are 3 children including C1 and C2 in classroom Adventure Depo under supervision of Staff #1 (S1). After the previous incident staff are supervising more and keep the boys separated. The 3 children get combined with another classroom on the playground on break times. During today's inspection a tour of the facility was conducted. There were 2 children in the Adventure Depo (kindergarten) classroom with one teacher supervising; 10 children in the Glassell Station classroom (2 years old) with two staff supervising; 14 children in Conductor Corner classroom (3 years old) with two staff supervising; 10 children in Explore Express classroom (4 years old) with two staff supervising; and 6 toddlers in Chapman Junction classroom with two staff supervising. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. During today's inspection staff members and children were interviewed. During interview, Director admitted that she did not report to Community Care Licensing Department (CCLD) regarding the incident in 02/24/2022 due to information received from CPS Social worker and she thought she did not need to report to CCLD after reporting to CPS. (Continue next page)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/19/2022 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FIRST UNITED METHODIST CHURCH	FACILITY NUMBER: 304371198
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/19/2022 Section Cited	1 2 3 4 5 6 7	101212 Reporting Requirements (1) during the operation of the child care center of any of the events, a report shall be made to the Department... within the Department's next working day (D) Any suspected physical or psychological abuse of any child. This requirement was not met evidenced by:
	8 9 10 11 12 13 14	Based on interview, Director admitted that she did not report to the Department a suspected child abuse on 02/24/2022, which poses a potential risk for the safety of the children care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: FIRST UNITED METHODIST CHURCH	FACILITY NUMBER: 304371198
	VISIT DATE: 04/19/2022

NARRATIVE

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(Page 2 of Report)

During staff interviews, Staff #1 (S1) denied witnessing C1 and C2 having interactions regarding the above incident but shared that C1's parent informed S1 of the concern. S1 did report to the Director and kept being vigilant on the C1 and C2 in class. S1 also communicated the concern to other teachers, who supervised the children on the playground, so that they can be vigilant on supervision for the C1 and C2 during recess. Staff #2 (S2), Staff #3 (S3), Staff #4 (S4), and Staff #5 (S5) also denied witnessing C1 exposing private part to C2 or hearing any interaction between C1 and C2, that C2 asked C1 to show private part to C2. All interviewed staff also provided information regarding supervision during recess: Staffs, who are providing supervision at recess, are stationed in 4 corners of the playground to provide supervision and children are redirected not to go under the play structure, which is a blinding spot for supervision.

During children interviews, both C1 and C2 shared that they were always supervised by the teachers in class and out on the playground during recess.

Based on LPA’s interview conducted with Director, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101212 Reporting Requirements. The deficiency is being cited on the attached 809D.

Based on the LPA's interviews with staff and children, there is insufficient information at this time. The case management needs further investigations pending the CAR report and additional interviews.

Exit interview was conducted with director. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Director 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. Appeal rights provided and explained. Director Cheri Payne was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights.

(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: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC809 (FAS) - (06/04)

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