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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606917
Report Date: 05/01/2025
Date Signed: 05/01/2025 03:22:18 PM

Document Has Been Signed on 05/01/2025 03:22 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:IRVINE CHILD DEVELOPMENT CENTER-INFANTFACILITY NUMBER:
300606917
ADMINISTRATOR/
DIRECTOR:		TUCKER, LISAFACILITY TYPE:
830
ADDRESS:2 CIVIC CENTER PLAZATELEPHONE:
(949) 724-6700
CITY:IRVINESTATE: CAZIP CODE:
92606
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 25DATE:
05/01/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:DirectorTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analysts (LPA), Mahnaz (Nancy) Malek, and Kathy Trinh conducted an onsite case management inspection for the purpose of investigating an incident that the facility self reported to our office on 4/29/2025.

LPAs met with director, Lisa Tucker. Census was taken. There were a 5 awake children with 2 staff in the infant room, 5 napping children with one staff in infant napping room, and 15 napping toddlers with 2 staff in the toddler napping room. According to the self incident report, 17 months child (C1) was left unattended for almost 5 minutes in the diaper room area.

A review of the Facility Personnel Report Summary on this date indicates all facility who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Based on the gathered information S1 and S2 were in the infant room on 4/28/2025 at 5:45pm. There is a small gate equipped with a latch installed between the diaper area and infant room. C1 was pushing the gate which was accidentally half open. S2 went to stop C1. At this time S1 was distracted by attending to S2. At this time, the gate was open and C1 went to the diaper area where the children's restroom was without staff being noticed. According to S1 after 5 minutes S1 noticed C1 was not in the room. S1 started looking for C1. Then C1 was found in the children's restroom playing with water in the toilet in the diaper area. It was estimated C1 was left unsupervised for 5 minutes.
Continued on page 2
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Mahnaz Malek
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: IRVINE CHILD DEVELOPMENT CENTER-INFANT
FACILITY NUMBER: 300606917
VISIT DATE: 05/01/2025
NARRATIVE
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According to interviews, reviewing the written self report incident dated 4/28/2025, and some supporting documents obtaining today, violation of lack of supervision has been occurred.

In the areas that were evaluated, the following deficiency of Responsibility for Providing Care and Supervision for Infants- Section 101429(a)(1) was observed of the California Code of Regulations, Title 22, Division 12 on today's investigation regarding the incident. Please see next page LIC 809D for detail of deficiency.

Lisa Tucker, the director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00. LPA Malek informed the director, Lisa Tucker that this report dated 5/1/2025 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.

Also, LPAs Malek and Trinh informed the director, Lisa Tucker to provide a copy of this licensing report dated 5/1/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The director, Lisa Tucker, was provided with 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. The exit interview was conducted with director, Barbara Brown.

End of report.

NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Mahnaz Malek
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/01/2025 03:22 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 05/01/2025 at 02:28 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: IRVINE CHILD DEVELOPMENT CENTER-INFANT
FACILITY NUMBER: 300606917

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2025
Section Cited
CCR
101429(a)(1)

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Responsibility for Providing Care and Supervision for Infants- Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. The above requirement was not met as evidenced by facility self report, and admission of S1
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The director agreed to review the process of constant supervision on children and handling emergency situations appropriately with staff. A review of discussion and understanding the process with the staff will be conducted.
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today that S1 was distracted by attending to S2. C1 left the infant room towards the restroom in the diaper area without S1 being noticed. C1 was found after 5 minutes. C1 was left unattended approximately 5 minutes. This is an immediate risk to the health and safety of children in care.
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The statement with the staffs' signatures acknowledging the importance of a supervision of children at all times and handling emergency situations will be sent to our office by the due date of 5/2/2025.

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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.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Mahnaz Malek
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2025


LIC809 (FAS) - (06/04)
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