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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371444
Report Date: 01/24/2022
Date Signed: 01/24/2022 11:27:11 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:MERRY HIVEFACILITY NUMBER:
304371444
ADMINISTRATOR:MELNIK, SVETLANAFACILITY TYPE:
850
ADDRESS:23802 AVENIDA DE LA CARLOTATELEPHONE:
(714) 872-3008
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:30CENSUS: 7DATE:
01/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Veronica AlvarezTIME COMPLETED:
12:00 PM
NARRATIVE
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On 1/24/22 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a case management inspection of the facility. LPA met with staff in charge Veronica Alvarez. The Covid-19 Emergency Response questionnaire was reviewed and answered. LPA observed 7 preschool children with 2 staff including Ms. Alvarez. A review of staff 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.

During the inspection and interview with director on 12/7/21, LPA learned adult # 1 worked at the facility on Wednesday 11/17/21, Thursday 11/18/21, and Friday 11/19/21 for two or three hours. Monday 11/22/21, Tuesday 11/23/21, and 11/24/21 for two or three hours. According to the information obtained the adult worked at the facility for less than 16 hours a week without any documents or paperwork. The director stated adult # 1 was not hired yet and she had the adult # 1 on a trial basis. The director stated she would ask for paperwork if she wanted to hire her later. According to adult # 1 she was not left alone with children.

In the areas evaluated, the following deficiencies were observed and cited today per CA Code of Regulations, Title 22, and Division 12: Personnel Requirements- section 101217(b)(1) and section 101217(b)(2) on LIC 809D.



Notice of Site Visit was posted. The notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The licensee was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights.
Exit interview was conducted with Ms. Alvarez.
This report ends here.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2022
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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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: MERRY HIVE
FACILITY NUMBER: 304371444
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2022
Section Cited

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Personnel Requirements- 101217(b)(1)Personnel records shall be maintained for all volunteers and shall contain the following: A health statement as specified in Section 101216(g). This requirement was not met as evidenced by interviews that adult # 1 worked at the facility on Wednesday 11/17/21, Thursday 11/18/21, and Friday 11/19/21
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for two or three hours. Monday 11/22/21, Tuesday 11/23/21, and 11/24/21 for two or three hours. There were no paperwork on file for adult # 1 for the above requirement.
This is a potential risk to the health and safety of children in care.
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Type B
01/27/2022
Section Cited

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Personnel Requirements- 101217(b)(2)Personnel records shall be maintained for all volunteers and shall contain the following: Health-screening records and results of tuberculosis tests as specified in Section 101216(g).This requirement was not met as evidenced by interviews that adult # 1 worked at the facility on Wednesday 11/17/21.
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Thursday 11/18/21, and Friday 11/19/21 for two or three hours. Monday 11/22/21, Tuesday 11/23/21, and 11/24/21 for two or three hours. There were no paperwork on file for adult # 1 for the above requirement.
This is a potential risk to the health and safety of 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) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2022
LIC809 (FAS) - (06/04)
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