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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370109
Report Date: 08/20/2024
Date Signed: 11/20/2024 01:27:57 PM

Document Has Been Signed on 11/20/2024 01:27 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/
DIRECTOR:
DALVA-HORNBACK, SHEILAFACILITY TYPE:
850
ADDRESS:1 FEDERATION WAY, STE. 200TELEPHONE:
(949) 435-3400
CITY:IRVINESTATE: CAZIP CODE:
92603
CAPACITY: 340TOTAL ENROLLED CHILDREN: 340CENSUS: 0DATE:
08/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Shelia Dalva Hornback Director TIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Patricia Duron conducted a Case Management Inspection to investigate previous deficiency which was cited during an investigation dated 8/22/2023. LPA Duron informed the director of the purpose of the visit. LPA met with Director, Sheila Dalva-Hornback. LPA observed 0 preschool children with 2 staff members.

During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 8/22/2023 facility was cited, California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101229(a)(1) Responsibility for Providing Care and Supervision: On 4/14/2023 a child received a scratch on the hand after waking up from nap and the 2 staff members who were supervising C1 did not know how the child received the scratch. 101223(a)(3) Personal Rights: S1 admitted knocking over a child’s magnet tile tower because the child knocked over another child's tower.

LPA Duron conducted this inspection to review facility’s procedures to ensure facility is following California Code of Regulations, Title 22 Regulations, Division 12. The facility uses Tad poles App, LPA observed Tad poles App on Director’s phone, Director stated all staff are able to check in a child when they are present in the classrooms once the child is signed in by parent/authorized representative. Parents sign child in/out, and staff will check in child when they are present in classrooms, and when child is signed out, staff will check child out on Tad Poles app to update the count. Director is able to view all children present in each room with updated counts throughout the day.



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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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: JCC EARLY CHILDHOOD LEARNING CENTER
FACILITY NUMBER: 304370109
VISIT DATE: 08/20/2024
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An interview with Director, was conducted. Since April 2023, we have continuously provided S1 with ongoing bi-weekly coaching with HR consultant to provide strategies and techniques when interacting with challenging behaviors. S1 is given assignments for example watching videos and reading articles with topics regarding anger management, and child development techniques. Director stated staff work collaboratively, and step in to support one another. Director stated facility provides staff in-services trainings with topics regarding licensing regulations, supervision, and child development. Any other updates ?

In the areas that were evaluated, No deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.



An exit interview conducted, and report was reviewed with the Director, Sheila Dalva-Hornback. 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. The facility representative 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.

Appeal Rights were discussed. The facility representative was provided 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.

Page 2 of 2. End of Report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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