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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312843
Report Date: 06/13/2024
Date Signed: 06/13/2024 03:16:20 PM

Document Has Been Signed on 06/13/2024 03:16 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:LEE, RAISSAFACILITY NUMBER:
304312843
ADMINISTRATOR/
DIRECTOR:		LEE, RAISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 387-6197
CITY:IRVINESTATE: CAZIP CODE:
92614
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
06/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Licensee, Raissa Lee TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valdez Santana conducted an on-site inspection for the purpose of a Case Management Incident Inspection on 6/13/2024, LPA toured the facility. Census was taken, there were 6 preschool age-children present supervised by the licensee and her assistants. This is the continuation of the investigation initiated on 5/22/24. In response to a self-reported incident, it was reported to the OC CCL office on 05/21/24, detailing child #1 (C1), had wandered away from the licensee during an outside walk.

During the inspection, LPA interviewed the licensee and child #1 (C1) involved in the incident. LPA also inspected the possible path C1 may have taken when leaving the licensee. LPA reviewed the Incident Report with facility representative as well as the response of the facility. On 5/21/2024, it is estimated that C1 walked about .03 miles from the fork in the walking trail to the licensee’s home. The licensee stated, she takes the children on daily walks throughout the neighborhood and on 5/21/24, as licensee was taking the children to the walking trail, three children started to run ahead of licensee. Licensee went after the three children. C1 was next to licensee. As soon as licensee caught up with the three students, licensee turned around, licensee could not find C1. LPA interviewed C1 who stated C1 left the licensee and the group of children and went down a different path because there were purple flowers down that particular path, that C1 was fond of. Licensee provided a photo taken while the children were on their walk from 11:35am- 11:40am that shows all children were present. Licensee stated she realized C1 was missing at 11:42am. Licensee and neighbor started looking for C1. Licensee provided a screenshot of Ring camera footage showing neighbor arrived to the facility with C1 at 12:01pm. From the information LPA gathered during this inspection and staff interview, LPA determined that the facility staff failed to provide adequate supervision and C1 was able to wander off without staff knowing this is Title 22 violation.

Therefore, one Type A deficiency was observed of the California Code of Regulations, Title 22, Division 12 Section 102417(a) Operation of a Family Child Care Home. See attached LIC809D for documentation of deficiency. Page 1 of 2.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: LEE, RAISSA
FACILITY NUMBER: 304312843
VISIT DATE: 06/13/2024
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LPA Valdez Santana informed facility representative, that this report dated 6/13/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPA Valdez Santana also informed the facility representative to provide a copy of this licensing report dated 6/13/2024, 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.

Exit interview was conducted. The Notice of Site Visit was posted for no less than 30 consecutive days. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.



Page 2 of 2. End of Report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/13/2024 03:16 PM - It Cannot Be Edited


Created By: Dianna ValdezSantana On 06/13/2024 at 02:49 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: LEE, RAISSA
FACILITY NUMBER: 304312843

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2024
Section Cited
CCR
102417(a)

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102417(a) Operation of a Family Child Care Home: The licensee...shall ensure that children in care are supervised at all times...
This requirement was not met as evidenced by:
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Licensee stated, her son will now be her hired assistant. Licensee has started to use walking rope once again for all children to hold on to while on their walks. Licensee is also doing multiple name to face calls with the children during their walks.
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Licensee lost visual sight of child #1 (C1) while on a neighborhood walk with the daycare children. C1 was alone for approximately 15 minutes.
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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:Thuy Ho
LICENSING EVALUATOR NAME:Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
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