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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606472
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:57:19 PM

Document Has Been Signed on 02/09/2022 12:57 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:U.C. IRVINE-VERANO PRESCHOOLFACILITY NUMBER:
300606472
ADMINISTRATOR:BAE, LESLIEFACILITY TYPE:
850
ADDRESS:3300 SOUTH VERANO ROADTELEPHONE:
(949) 824-4755
CITY:IRVINESTATE: CAZIP CODE:
92617
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 13DATE:
02/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Leslie Bae, DirectorTIME COMPLETED:
01:00 PM
NARRATIVE
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On 02/09/2022, Licensing Program Analysts (LPA) Nguyen Tran conducted a case management inspection to follow up on a self-report unusual incident that was submitted to Community Care Licensing Regional Office on 01/28/2022. It was reported by Leslie Bae, Director.

During today's inspection a tour of the facility was conducted. There were 13 children on the playground and four staff supervising them. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. During today's inspection staff members were interviewed regarding the incident.

During the interviews, all staff members gave consistent statements when asked to describe the incident as followed. On 01/28/2022, during the transition from the playground to the classroom, staff were supervising 14 students when they were using the faucet right outside the classroom back door to wash their hands before entering the classroom. Staff #1 (S1) was stationed at the faucet area to ensure all children washed their hands appropriately. Staff #2 (S2) were in charge of counting the children by the door, however, S2 had to attend to a child who had a bathroom accident. During this time, Child #1 (C1) and another child were the last 2 outside and both heading towards the faucet to wash their hands, C1 started heading to the opposite direction of where the faucet was. Staff #3 (S3) was behind the children, and as she was walking behind them, S3 picked up a trash on the ground and did not see C1 went the opposite direction from the group. The children returned into the classroom and staff believed all children were inside. Approximately 30 seconds, staff heard a knock at the door and found C1 was outside. Staff immediately let C1 into the class and reported the incident to the Director.

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, Section 101229(a)(1) Responsibility for Providing Care and Supervision. The deficiency is being cited on the attached 809D.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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: U.C. IRVINE-VERANO PRESCHOOL
FACILITY NUMBER: 300606472
VISIT DATE: 02/09/2022
NARRATIVE
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(Page 2 of Report)

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. 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. Appeal rights provided and explained. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Director was informed of how/where to access regulations and forms from CCLD websites: www.ccld.ca.gov or Myccl.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2022 12:57 PM - It Cannot Be Edited


Created By: Nguyen K Tran On 02/09/2022 at 12:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: U.C. IRVINE-VERANO PRESCHOOL
FACILITY NUMBER: 300606472

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2022
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision...(1) 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).

This requirement is not met as evidenced by:
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Director had a staff meeting on 01/31/2022 discussing their policies and retraining staff to ensure this type of incident will not occur again. Copies of the policy with staff initial and date, indicating they read it.
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Based on interview, staff did not provide supervision for one child within one minute as children were transitioning inside of the classroom.
This poses a potential risk to the safety of children in care.
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Doumentation of the staff meeting and copies of the policy with staff initial and date, indicating they read it, were obtained on this day.

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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 Lopez
LICENSING EVALUATOR NAME:Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022


LIC809 (FAS) - (06/04)
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