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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370617
Report Date: 11/08/2023
Date Signed: 11/08/2023 05:11:29 PM


Document Has Been Signed on 11/08/2023 05:11 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CCLC-ZIGGURAT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
304370617
ADMINISTRATOR:MCCARTHY, KELLYFACILITY TYPE:
850
ADDRESS:24000 AVILA ROADTELEPHONE:
(949) 360-2004
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:58CENSUS: 18DATE:
11/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Assistant director Ana GarciaTIME COMPLETED:
05:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite case management inspection for the purpose of checking into an incident that facility reported to our office on 11/3/2023. LPA met with assistant director, Ana Garcia. The director, Kelly McCarthy was not present today. The assistant director, Ana Garcia gave LPA a tour of the facility inside and outside. LPA took census, there were a total of 10 preschool children present with 2 staff in one classroom, and 8 preschool children with 4 staff in another classroom. The 3rd classroom was not in use. According to the self report, a 2 year old child was left unattended on the playground during transitioning from outside to inside the classroom on 11/3/23. The report stated the absence of supervision was for one minute.

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.

Today LPA interviewed the assistant director and 3 other staff who were involved in this incident. (Staff # 1, 2, and 3). It was found out that there were 3 staff with 8 children on the playground. Staff # 3 was inside the classroom to prepare children's lunch. Staff # 1 and 2 remained outside with 8 children. They started transitioning 8 children from outside to inside the classroom around 11:03 am. According to staff # 1 children were instructed to sit by the classroom wall so staff # 1 could do a name to face check. Staff # 1 stated she made a mistake and did not do a face to name completely and checked the child off as present. Staff # 2 went inside with few children to wash their hands. Staff # 1 thought all the children came inside. Staff # 1 closed the classroom door not knowing 2 year old child was left on the playground. The classroom door immediately leads to the playground. Staff # 1 stated she started to take roll again by checking name to face for the 2nd time. At this time staff # 2 noticed child was not in the classroom. They went on the
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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CCLC-ZIGGURAT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 304370617
VISIT DATE: 11/08/2023
NARRATIVE
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playground and found the child sitting at the bench table on the playground. Staff # 1 thinks the absence of supervision was for 30 seconds. Staff # 2 states absence of supervision was for one minute and staff # 3 states absence of supervision was for a minute or two.

In the areas that were evaluated, the following deficiency was cited of the California Code of Regulations, Title 22, Division 12 Section 101229(a)(1) for Responsibility for Providing Care and Supervision. An immediate Civil Penalty of $500.00 and 100.00 per day if not corrected was assessed for absence of supervision.

A notice of site visit was given to assistant director, Ana Garcia and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.


LPA Malek informed assistant director, Ana Garcia that this report dated 11/8/2023 document 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.

Also, LPA Malek informed the assistant director, Ana Garcia to provide a copy of this licensing report dated 11/8/2023 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 conducted and report was reviewed with the assistant director, Ana Garcia.

End of report

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/08/2023 05:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CCLC-ZIGGURAT CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 304370617

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/09/2023
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. According to facility self report a 2 year old child was left unattended
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The assistant director stated they would have a meeting with staff to remind them of supervision of children at all times. They will have a training on recording name to face next week. The assistant director states she would send a statement of staffs' signatures
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on the playground for a minute or two. This happened during transitioning from outside to inside the classroom on 11/3/23. There were 8 children with 3 staff. This is an immediate risk to the health and safety of children in care. Immediate civil penalty of 500.00 was assessed today for absence of supervision,
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acknowledging the importance of visual supervision at all times. The assistant director will send the plan of correction to LPA by the due date of 11/10/2023

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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 HoTELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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