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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603522
Report Date: 07/18/2024
Date Signed: 07/18/2024 09:55:19 AM

Document Has Been Signed on 07/18/2024 09:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GRACE HARBOR CHURCH AND SCHOOLFACILITY NUMBER:
300603522
ADMINISTRATOR/
DIRECTOR:
REBEKAH BAYFACILITY TYPE:
850
ADDRESS:12881 NEWPORT AVENUETELEPHONE:
(714) 544-4431
CITY:TUSTINSTATE: CAZIP CODE:
92780
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: 31DATE:
07/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Director Rebekah BayTIME VISIT/
INSPECTION COMPLETED:
10:10 AM
NARRATIVE
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On 07/18/24 at 8:45am, A case management incident inspection was conducted today by Licensing Program Analyst (LPA) Chan who met with the director Rebekah Bay. A self-reported incident by the facility was received at the regional office on 07/12/24 which stated that on 7/10/24, Child #1 (C1) sustained an injury while at the play yard. Upon arrival there were 5 staff present and 31 children in care. Children were at the play yard when LPA arrived.

A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA reviewed Incident Report, Ouch Reports, Interviewed 6 staff and interviewed C1. LPA obtained a copy of ouch reports.

Staff stated first aid was applied in the injury, and director notified parents through a phone call and documented through Procare to parents.

LPA observed children in the play yard.

Director was provided a copy of California Code or Regulations, Title 22, Section 101212 Reporting Requirements.

No deficiencies cited during this visit.



Exit interview was conducted with director Rebekah Bay. The Notice of Site Visit was posted. 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 was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledge receipt of these rights. The first level appeal is to Regional Manager, address is above on the report.

End of Report

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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