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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370109
Report Date: 08/22/2023
Date Signed: 08/22/2023 01:00:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2023 and conducted by Evaluator Patricia Duron
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230424150638
FACILITY NAME:JCC EARLY CHILDHOOD LEARNING CENTERFACILITY NUMBER:
304370109
ADMINISTRATOR:DALVA-HORNBACK, SHEILAFACILITY TYPE:
850
ADDRESS:1 FEDERATION WAY, STE. 200TELEPHONE:
(949) 435-3400
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY:340CENSUS: 0DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sheila Dalva-Hornback, Director TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff member used an inappropriate form of discipline with day care child in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Duron conducted an unannounced complaint visit to deliver the complaint findings. LPA met with director, Sheila Dalva-Hornback.Census was taken.The overall census observed was 2 staff and 0 children. A review of staff criminal clearance 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 or exemptions.
On 4/24/2023 a complaint was filed with the Licensing office stating staff member used an inappropriate form of discipline with day care child in care. RP stated a staff member knocked over a child’s block to teach this child a lesson because the child took a block from another child.
During the course of investigation, LPA interviewed 6 staff members, 4 parents, 4 children and reviewed records.
During the interview, Adult 1 (A1) stated C1 was playing with the magnet tiles and other children began to go over to that same area to build with C1. C1 took a magnet tile from another child and part of their tower fell. Page 1 of 2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 06-CC-20230424150638
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JCC EARLY CHILDHOOD LEARNING CENTER
FACILITY NUMBER: 304370109
VISIT DATE: 08/22/2023
NARRATIVE
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The child went to tell Staff #5 (S5) that C1 destroyed their building. S5 asked C1 which one is C5’s tower and C1 pointed to the C1’s tower. S5 opened the hand and smashed C1’s tower. S5 said to C1 “How does that make you feel?” S5 added, those are the consequences.
LPA interviewed S5, S5 stated C1 was playing with magnet tiles and a student came up to S5 and said C1 knocked over their magnet tiles, so S5 went over and knocked down C1 magnet tiles. C1 was very upset and S5 asked if C1 wanted S5 to help rebuilding the tower, and S5 helped C1 for a bit. Then S5 needed to help clean up so S5 told C1 that C1 was doing a great job, and C1 could continue building alone. S5 stated C1 did cry for about 10 minutes, and C1 stated “I don’t like it”. S5 stated S5 told C1 “I don’t like when you do it either to my friends”.

LPA Duron interviewed 4 parents. All interviewed parents stated they did not have any concern with facility.

Based on LPA’s interviews, and staff admitting to knocking down the tower to teach the child a lesson, and reviewing records, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101223(a)(3) Personal Rights. Please refer to attached 9099D for documentation of deficiencies.



LPA Duron informed Director, Sheila Dalva-Hornback that this report dated 8/22/23 documents One 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. LPA Duron informed the Director to provide a copy of this licensing report dated 8/22/23 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.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were provided. The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.


The 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 $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Page 2 of 2. End of Report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 06-CC-20230424150638
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JCC EARLY CHILDHOOD LEARNING CENTER
FACILITY NUMBER: 304370109
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2023
Section Cited
CCR
101223(a)(3)
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101223(a)(3) Personal Rights(3) 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 living....aids to physical functioning.
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Director provided LPA with a written statement plan. Director is conducting a Professional Development trianing for the week of 8/21-8/25, 2023. Director will emphasize on the importance of children's personal rights. Director will provide LPA with a list of staff with signatures, that received the training due 9-1-23. Staff #5 will continue to meet with HR consultant.
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This requirement is not met as evidence by:Based on LPA’s interviews,S5 admitted knocking over C1’s magnet tiles tower because C1 took a magnet tile from other child.A1 disclosed witnessing S5 knocked over C1's magnet tile tower. The action poses an immediate risk to the health of child 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2023 and conducted by Evaluator Patricia Duron
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20230424150638

FACILITY NAME:JCC EARLY CHILDHOOD LEARNING CENTERFACILITY NUMBER:
304370109
ADMINISTRATOR:DALVA-HORNBACK, SHEILAFACILITY TYPE:
850
ADDRESS:1 FEDERATION WAY, STE. 200TELEPHONE:
(949) 435-3400
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY:340CENSUS: 0DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sheila Dalva-Hornback, Director TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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2
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9
Staff member injured a day-care child.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Duron conducted an unannounced complaint visit to deliver the complaint findings. LPA met with director, Sheila Dalva-Hornback. Census was taken. The overall census observed was 2 staff and 0 children. A review of staff criminal clearance 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 or exemptions.
On 4/24/23 a complaint was filed with the Licensing office Reporting Party (RP) stated the following: Child (C1) was crying in the classroom and had fingernail marks or scratches on C1’s hand. RP also stated C1 disclosed teacher hurt C1’s hand by squeezing C1’s hand.
During the course of investigation, LPA interviewed 7 staff members, 4 parents, 4 children, and reviewed records.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20230424150638
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: JCC EARLY CHILDHOOD LEARNING CENTER
FACILITY NUMBER: 304370109
VISIT DATE: 08/22/2023
NARRATIVE
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During the initial inspection dated 4/28/23 during the staff interview, Staff #1 (S1) stated the following: On 4/14/2023, after nap children were getting up, getting ready for snack. S2 was getting ready for snack, and some kids wanted to get to their water, across the way so S1 said “Use walking feet”. C1 started running. S1 saw C1 tried to open the water so S1 walked over, and C1 began to run with water bottle in C1’s mouth. S1 placed S1 in front of C1 and asked C1 to wait. S1 said to C1 “I'm taking your cup and I will place it on the snack table”. C1 didn’t want to let go at first, and then C1 let go. S1 walked over to the table and placed C1’s water bottle on it. S1 said to C1 “When you’re ready, your cup is on the table.” C1 threw C1’s cup on the floor after running to the table then C1 started crying and yelling. S1 stated S1 did not injure child and indeed, S1 did not touch C1 when S1 removed water bottle from C1.

During the investigation, LPA interviewed S2 who was in the room with S1 and C1 during the incident on 4/14/2023, S2 disclosed the same statement as S1’s. S2 also stated S2 did not observed S1 did anything to hurt C1. S2 also confirmed did not know how C1 received the scratch on C1’s hand.

LPA Duron contacted and interviewed 4 parents, 4 out of 4 parents stated they did not have any concern with facility.

Based on the information gathered from LPAs’ interviews, observation, and reviewing records, there is insufficient evidence to corroborate the allegations of Staff member injured a day care child while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur in the day care facility, therefore the allegations are UNSUBSTANTIATED.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were provided. The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Any proposed changes to the physical plant, including telephone number, shall be immediately reported to the Department.




Page 2 of 2. End of the Report.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5