300603522-3-9-2023-06-CC-SGUZ-CPRUUX-20230309145416

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300603522
Report Date: 03/09/2023
Date Signed: 03/09/2023 02:54:23 PM

Document Has Been Signed on 03/09/2023 02:54 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:	GRACE HARBOR CHURCH AND SCHOOL		FACILITY NUMBER:	300603522
ADMINISTRATOR:	REBEKAH BAY		FACILITY TYPE:	850
ADDRESS:	12881 NEWPORT AVENUE		TELEPHONE:	(714) 544-4431
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92780
CAPACITY: 78	TOTAL ENROLLED CHILDREN: 52	CENSUS: 47	DATE:	03/09/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Rebakah Bay, Director		TIME COMPLETED:	11:30 AM

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	On 03/09/2023 Licensing Program analysts (LPAs), Stella Gutierrez made an unannounced visit to the facility for the purpose of a self reported incident that occurred at the facility on 03/03/2023. LPA was met by the , Rebekah Bay, director who was explained for the reason for today's visit. LPA observed 05 preschool staff and 47 preschool age children upon arrival. A review of the Facility Personnel Report Summary conducted on 03/09/2023 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. The assistant director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The facility self reported an incident that occurred at the facility on 03/03/2023. It was reported that a child was picked up by the parent and the child was observed running out of the facility towards the parking lot. The child was brought back in to the facility by another parent who was arriving. During today's visit LPAs interviewed 02 staff and observed the area where child was released and the procedure for the sign out process. On 03/09/2023 Staff #1 stated that when the child was picked up on 03/03/2023 that the parent signed the child out in the lobby and proceeded to the pick up are which is the play yard. When the parent arrived to the gate, the parent opened the gate and let the child out while asking Staff #1 a question. The child then ran through double doors to enter the lobby and proceeded to run through another set of double doors to exit the lobby out in to the parking lot where the child was approached by a the parent that escorted the child back inside. At this time the parent was already running after the child. Page 1 of

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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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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: GRACE HARBOR CHURCH AND SCHOOL	FACILITY NUMBER: 300603522
	VISIT DATE: 03/09/2023

NARRATIVE

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The director stated that when parents arrive they go through the double doors to exit the lobby and through a gate door that is closed to access the play yard to pick up the children. The director stated that the facility relies on the parents to shut the gate back.

During today's inspection observations and interviews it was revealed that the parent signed the child out and did not shut the gate to prevent the child from running out of the facility. It was further revealed that the operation of the pick up procedure may cause a potential risk to the children in care during released while depending on the parents to shut the gate to avoid children exiting the facility without adult supervision A consultation was provided to the director today on the pick up procedure to avoid the incident that occurred on 03/03/2022 happening again.

Based on LPAs observations and interviews there will be no citations issued today for this incident that occurred on 03/03/2023.

Exit interview conducted and report was reviewed with the Rebekah Bay, director. Appeal Rights were discussed. . The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC809 (FAS) - (06/04)

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