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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371217
Report Date: 06/14/2019
Date Signed: 06/14/2019 10:43:50 AM

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:LEPORT-HUNTINGTON HARBORFACILITY NUMBER:
304371217
ADMINISTRATOR:ASGHAR, FATIMAFACILITY TYPE:
830
ADDRESS:16081 WAIKIKI LANETELEPHONE:
(714) 377-6035
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY:120CENSUS: 85DATE:
06/14/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Cindy Hume, Assistant DirectorTIME COMPLETED:
11:15 AM
NARRATIVE
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An inspection was conducted at the facility by LPA Dean Valencia. The facility file was reviewed prior to this inspection being conducted. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance. LPA Valencia met with Assistant Director Cindy Hume. The inspection was conducted in response to an Unusual Incident Report received on 6/3/2019, in which child #1 (See Confidential Names List LIC811) fell down an indoor climbing structure and hit their ear on an indoor seat. Staff #1 had attended to the child's injury, provided first aid and notified the parent of the child who then took the child to urgent care where glue was applied to the cut. This incident was reported to licensing in a timely fashion, compliant with reporting requirement regulations. An inspection was conducted today, 6/14/19, to investigate into this unusual incident. During the course of the investigation staff related to the reported unusual incident were interviewed, a physical plant inspection was conducted, and census of children was taken. During the inspection the facility had 28 staff and 85 children present. LPA was able to determine that the staff #1 with child #1, had turned their back while this child was sitting on a bench. During that time, the child walked up a nearby play structure and left the bench they were supposed to be sitting and waiting at. The staff #1 then turned and instructed the child to return to the nearby bench. The child #1 then stumbled, fell and hit their ear on the bench arm. Although the lapse in supervision was for a very short time period, this still warrants a lack of compliance with regulations. Based on the information obtained during today's inspection regarding this reported incident, it was determined that the facility violated Title 22 Regulations related to Supervision, requiring all children not be left without visual supervision. This violation was determined to be a B violation, due to the very short period of lapse in supervision (approx. a few seconds), and the close proximity of the staff #1 to the child #1. The facility was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. Facility representative 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. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see attached LIC 809D.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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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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: LEPORT-HUNTINGTON HARBOR
FACILITY NUMBER: 304371217
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
CCR
101229(a)(1)
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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

Based on interviews with staff, it was
determined that staff #1 had turned their
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The assistant director stated that she will forward this infomration to the director and have the facility coordinate some training or a meeting to all infant/toddler staff to ensure that all staff are aware of the Supervision requirements to maintain visual supervision of all infants/toddlers at all times. Proof of this training/meeting will be submitted to LPA
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back, leaving child #1 without visual supervision. It was disclosed in an interview that the lapse of supervision was not more than a few seconds. During that time, child #1 left the chair and climbed up a nearby indoor step structure, approximately 3-4 feet away. Staff #1 turned back to child #1, instructing the child #1 to return to the bench where they previously were. At that time, the child stumbled and hit their ear on the arm of the bench, which needed medical attention. This lack of supervision has been determined to warrant a B violation due to the short lapse of supervision, and close proximity of the staff #1 to the child #1. This is a potential threat to the children's health and safety.
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by 6/28/19, and a staff sign in/out of what staff attemded this training/meeting will be included. LPA contact information was left with the assistant director.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: 714-703-2817
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
LIC809 (FAS) - (06/04)
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