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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270605
Report Date: 02/10/2022
Date Signed: 02/10/2022 11:38:18 AM

Document Has Been Signed on 02/10/2022 11:38 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MARINERS CHURCH PRESCHOOLFACILITY NUMBER:
304270605
ADMINISTRATOR:SCIABICA, LISAFACILITY TYPE:
850
ADDRESS:5001 NEWPORT COAST DRIVETELEPHONE:
(949) 769-8261
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY: 194TOTAL ENROLLED CHILDREN: 194CENSUS: 116DATE:
02/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Jennifer Eggers, DirectorTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Patricia Rivas conducted a follow -up case management visit to continue the investigation of two incident reports, which was commenced on 02/07/22. LPA was assisted by Director, Jennifer Eggers.

A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance. A Facility Risk assessment was conducted to determine the level of Personal Protective Equipment (PPE) was needed for an on-site inspection.

On 02/02/22 Regional Office received incident reports involving Staff #1(S1). Incident report of 02/02/22 involved Child#1(C1) and incident of 11/04/21 involved C2.

The investigation consisted of; Records reviewed, including staff and children files; interviews with staff, child, and others.

In reference to incident of 02/02/22 it was reported that S1 “pinched/squeezed” C1’s cheek with the left hand, while cradling C1 in S1’s arms. It was found C1 went to S2 pointing at their cheek and stating S1’s name. Interviews with S2 disclosed that S2 had observed incident but was unsure of the severity until she saw C1’s cheeks which had two red marks where index finger and thumb appeared to be imprinted and also noted red under chin. S2 reports S1 stated, “It was self-defense, …“child’s gender” was trying to bite me.” Interview with Director Ms. Eggers indicated that on 02/02/22, S1 told Director, “it was self-defense” . Director also stated, S1 has been dismissed. LPA interviewed 10 of 10 staff who report not observing any personal rights violations and being trained in personal rights. LPA attempted to interview S1 but S1 did not return calls. LPA attempted to interview C1 but LPA was unable to qualify child.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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: MARINERS CHURCH PRESCHOOL
FACILITY NUMBER: 304270605
VISIT DATE: 02/10/2022
NARRATIVE
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In reference to the incident of 11/04/21 it was reported that S1 had placed C2 in the bathroom because C2 was hitting another child. S1 had shut the half door to the bathroom preventing C2 from getting out and left C2 unattended while S1 changed other childs’ diapers. S2 immediately went over to bathroom and took the child out of the restroom. Interview with S2 indicated S2 had left the classroom to retrieve items from printer and was gone maybe a minute. S2 indicated S2 told S1 not to do that and S1 responded that Asst Director (now Director) had advised her she could place a child in bathroom and close door. S2 also verified S2 had not reported this incident until 02/02/22 believing what S1 had stated. Interview with Director Eggers (previously Asst. Director) denies giving S1 that advice. LPA interviewed family member who report no concerns and satisfied that C2 is safe based on actions taken by Director. Director stated, S1 has been dismissed. LPA attempted to interview S1 but S1 did not return calls. LPA interviewed 10 of 10 staff who indicated they were never instructed by Director Eggers to place/lock a child in a bathroom as a means of separating children when only 1 staff is present. LPA attempted to interview C2 but LPA was unable to qualify child.

The following deficiencies are cited under The California Code of Regulations, Title 22 Division 12 Chapters 1 on 809(d).

An exit interview was conducted with Director, Eggers. Appeal Rights were explained. The licensee was provided a copy of appeal rights (LIC 9058 01/16) 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. First level appeals should be sent to the regional manager to the address listed above.

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.

LPA, Patricia Rivas informed Director, Jennifer Eggers that this report dated 02/10/22 document(s) Two Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Rivas informed Director Eggers to provide a copy of this licensing report dated 02/10/22 that documents any Type A citation(s) 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.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2022 11:38 AM - It Cannot Be Edited


Created By: Pat Rivas On 02/10/2022 at 09:50 AM
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: MARINERS CHURCH PRESCHOOL
FACILITY NUMBER: 304270605

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2022
Section Cited
CCR
101223(a)3

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Personal Rights;
The licensee shall ensure that each child is accorded the following personal rights; To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily
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Director dismissed S1 and has trained all staff in personal rights as of 02/08/22; Copy of training will be provided by tomorrow.
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living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by witness statement they observed S1 pinch/squeeze C1’s
cheeks leaving red marks on cheeks and under chin also hearing S1 state, “it was self defense” . This poses an immediate risk to children in care.
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Type A
02/11/2022
Section Cited
CCR101223(a)6

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Personal Rights
The licensee shall ensure that each child is accorded the following personal rights; Not to be locked in any room, building or center premises by day or night. This requirement was not met as evidenced by witness
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Director dismissed S1 and has trained all staff in personal rights as of 02/08/22; Copy of training to be provided by end of 02/11/22. S2 is to be retrained in mandated reporter training timelines
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statement that they observed C2 in bathroom with half door to the bathroom shut, preventing C2 from getting out. This poses an immediate risk to 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 Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


LIC809 (FAS) - (06/04)
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