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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370109
Report Date: 10/13/2022
Date Signed: 10/13/2022 03:59:09 PM

Document Has Been Signed on 10/13/2022 03:59 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: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: 340TOTAL ENROLLED CHILDREN: 197CENSUS: 130DATE:
10/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Shelia Dalva-Hornback, DirectorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an unannounced case management incident inspection in response to a self-report Unusual Incident dated 09/30/2022. LPA met with Sheila Dalva-Hornback, Director, LPA toured the facility. Census was taken. LPA observed 130 children present, with 42 staff supervising.

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 09/30/2022 an self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported a child disclosed to parents that a younger teacher had pulled her ear in the classroom. According to the assistant director, they conducted an internal investigation and it was determined that the teacher did not pull the child’s ear. Per assistant director, on 09/23/2022, parents took child to the doctor, in case child had an infection or to find out why the child’s ear was hurting, nothing was discovered at the doctor, as to why the child’s ear was hurting.

During today’s visit, LPA Torrence interviewed 4 staff members. There were no disclosure made by the four interviewed staff.

During today’s inspection, there were no deficiency cited per California Code of Regulation, Title 22.

Exit interview was conducted. The Notice of Site Visit was posted. Director 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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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