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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370681
Report Date: 11/29/2023
Date Signed: 11/29/2023 10:41:41 AM


Document Has Been Signed on 11/29/2023 10:41 AM - 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:IREMNANTFACILITY NUMBER:
304370681
ADMINISTRATOR:SONG, LYDIA MI SOOKFACILITY TYPE:
850
ADDRESS:1521 D W. ORANGETHORPE AVE.TELEPHONE:
(714) 882-0860
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY:88CENSUS: 36DATE:
11/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Grace Kang Director TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Patricia Duron conducted an unannounced case management investigation for the incident which the facility self-reported an unusual incident to licensing office on 09/20/23. LPA met with director Grace Kang. LPA observed 6 staff members and 36 preschool children in care.

A review of facility Personnel Report Summary 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.

The unusual incident report stated an unusual incident occurred at the facility on 9/19/23, the Director stated Child #1 (C1) and Staff #1 (S1) were in classroom, a parent (P1) heard yelling and heard a staff saying "stop crying". Director stated that P1 stated they witnessed S1 shaking C1's body and head.

During the course of investigation, LPA interviewed 4 staff members, 3 children, reviewed records and video footage.

LPA Duron interviewed 3 children. 2 out of 3 children disclosed S1 has a mad voice and is mad a lot. C2 stated S1 is mad a lot and has a mad voice. C3 stated S1 is the maddest.

LPA reviewed video footage of incident that occurred on 9/20/23. During review of video footage, LPA observed S1 handing C1 in a rough manner. LPA observed S1 yelling at C1, S1 continuously saying stop and say yes. LPA observed S1 wiping C1’s nose as S1 moved C1’s head back and forth in a rough manner while C1 was crying.

LPA interviewed staff. Management stated S1 is no longer employed at the facility and is no longer caring for children at the facility. S4 stated facility recently reviewed conscious discipline training, to ensure positive redirection.

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SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Patricia DuronTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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: IREMNANT
FACILITY NUMBER: 304370681
VISIT DATE: 11/29/2023
NARRATIVE
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Based on LPA’s interviews, observations 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 Personal Rights (a)(3). Please refer to attached 9099D for documentation of deficiencies.

This requirement is met as evidence by: Based on LPA’s interview and observation of video footage of incident that documents S1 handing C1 in a rough manner, which poses an immediate health risk to the children in care.

LPA Duron informed Director, Grace Kang that this report dated 11/29/23 documents one Type A citation which shall be posted for 30 consecutive days as there is an 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 11/29/23 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.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Patricia DuronTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 11/29/2023 10:41 AM - 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: IREMNANT
FACILITY NUMBER: 304370681

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/29/2023
Section Cited
HSC
101223(a)(3)

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101223 Personal Rights(a)(3) The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat....aids physical functioning.
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Director stated S1 is no longer employed at the facility and is no longer caring for children at the facility. Director has reviewed and provided staff with conscious discipline training, to ensure positive redirection. Director provided LPA with staff signed documenets stating they have viewed Licensing videos on Ratio, Supervision. and Personal Rights.
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This requirement is not met as evidence by: Based on LPA’s record review, LPA reviewed video footage of incident that occurred on 9/19/23. During review of video footage, LPA observed S1 handing C1 in a rough manner. LPA observed S1 yelling at C1, S1 continuously saying stop and say yes. LPA observed S1 wiping C1’s nose as S1 moved C1’s head back and forth in a rough manner while child was crying. This action poses an immediate risk to the health and safety to the 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.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Patricia DuronTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3