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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371198
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:08:33 PM


Document Has Been Signed on 04/20/2023 02:08 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 CHURCHFACILITY NUMBER:
304371198
ADMINISTRATOR:CHERI PAYNEFACILITY TYPE:
850
ADDRESS:161 SOUTH ORANGETELEPHONE:
(714) 316-5933
CITY:ORANGESTATE: CAZIP CODE:
92866
CAPACITY:60CENSUS: 53DATE:
04/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cheri Payne, DirectorTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tran conducted a case management visit to address a violation of facility was operating out of ratio, which was discovered during an investigation. LPA met with Director Cheri Payne and informed the Director of the purpose of the visit. During today's visit, a tour of the facility was conducted. The overall census observed was 45 preschool children and 8 toddlers supervised by 7 staff in the 5 classrooms.

During an investigation, in which, both staff #4 (S4) and the Director confirmed that S4, who did not meet qualification to work alone with the toddlers, was providing care for 2 toddlers alone on 02/22/2023, while the Director was meeting with the main teacher of the toddler classroom for about 30-45 minutes, between 5pm and 6pm. Due to having unqualified staff, S4 working alone with the toddlers, facility was operating out of ratio in the toddler component.

Based on LPA’s interviews conducted with staff, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Sub Chapter 2 Section 101416.5(b) Staff-Infant Ratio is being cited on the attached LIC9099D.

Due to the Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058) was provided. First level appeal is to Regional Manager, address is above on the report.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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 04/20/2023 02:08 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: 04/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2023
Section Cited

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101416.5 Staff-Infant Ratio (b) There shall be a ratio of one teacher for every four infants in attendance.

This requeriment was not met evidenced by:
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Director states that she will submit a statement of understanding of the regulation and detailed plan to ensure ratio are being met, to LPA by due date.
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Based on LPAs interviews and record review, Director and Staff#4 confirmed that S4, who were not qualified, had provided care for the toddler alone on 02/22/2023, which put the facility out of ratio, this posed an immediate risk to the health, safety and personal rights of the 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: Rina LopezTELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K TranTELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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