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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370734
Report Date: 12/19/2023
Date Signed: 12/19/2023 02:22:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 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
11/03/2023 and conducted by Evaluator Anna Francesca Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20231103161859
FACILITY NAME:FUN 4 KIDS PRESCHOOLFACILITY NUMBER:
304370734
ADMINISTRATOR:SILVA, DAWNFACILITY TYPE:
850
ADDRESS:23721 LA PALMA AVENUETELEPHONE:
(714) 694-0901
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY:76CENSUS: 30DATE:
12/19/2023
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Director Melissa WojickTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Reporting Requirements
Health Related Services
INVESTIGATION FINDINGS:
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On 12/19/2023, at 11:55am Licensing Program Analyst (LPA), Anna Chan conducted an unannounced Complaint investigation inspection. This is a continuation of the investigation initiated on 11/9/2023. Upon arrival, LPA met with Director, Melissa Wojick and informed the director of the purpose of the visit and to deliver findings. LPA was led on walk through of the facility by the director and a census was taken. LPA observed 4 staff and 30 preschool children.

A review of the Facility Personnel Report Summary shows all facility staff or individuals who require caregiver background checks have received a criminal record clearance and a child abuse index clearance or an exemption clearance.

The Department received a complaint on 11/03/2023 alleging (1) Staff did not seek medical attention in a timely manner. (2) Staff did not follow the child’s medication plan.
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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
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 4
Control Number 06-CC-20231103161859
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2023
Section Cited
CCR
101226(c)
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Health-Related Services
(c) The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized representative...
This requirement is not met as evidence by:
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Director stated they had a training on daily health inspections or cursory check with staff and medical safety procedured on how to check medication and who is authorized to administer medication. Director will provide a copy via email to LPA with statement by POC due date.
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Based on interview and record review, staff did not seek medical treatment when child's face had bump the later on found out it was due to allergic reaction. Child's eye was shut and could not open.
This poses an immediate health, safety or personal rights risk to persons in care.
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Type B
01/19/2024
Section Cited
CCR
101226.3(e)(3)(A)
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101226 Health-Related Services
Health Related Services
(e) In centers where the licensee chooses to handle medications: (3) Prescription medications may be administered... (A) Prescription medications shall be administered in accordance with the label ..
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Director stated they had a training on daily health inspections or cursory check with staff and medical safety procedured on how to check medication and who is authorized to administer medication. Director will provide a copy via email to LPA with statement by POC due date.
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This evidence is not met by:
Based on interview and record review, facility did not administer medication in accordance with child's concent and medication plan. Which led to an emergency call.
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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: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20231103161859
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734
VISIT DATE: 12/19/2023
NARRATIVE
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Interview with the complainant: On 11/7/2023, the LPA called the reporting party (RP), according to the interview, RP stated child (C1) has severe allergies. On 10/24/23, when RP was picking up C1, RP noticed C1 had a bump on the face, RP reported that the bump was golf ball size and one of C1’s eyes was shut. RP immediately asked the staff to call 911. The ambulance came and administered EpiPen. C1 was brought by the ambulance to the emergency room. RP stated the facility did not notify them that C1 had a bump on their face. RP reported that there was a written plan in place with the facility that was not followed.

Interview with staff: On 11/10/2023, LPA interviewed three (3) staff. Staff #1 (S1) confirmed that S1 is aware that C1 has severe allergies. Two (2) staff confirmed that there was an incident with C1 having a bump on the face and parent #1 (P1) had to ask them to call 911. The 2 staff confirmed that P1 and C1 went with C1 in the ambulance. S1 stated that P1 was not notified about C1’s bump because they did not notice the bump during the day. S3 also confirm that prescription medication for C1 was not administered.

Interview with Parents: On 12/14/2023, LPA called parents five (5) parents. LPA reached three (3) parents. The other parents did not respond to the Department’s request for an interview. Two parents interviewed did not disclose any information that could support the allegations. One (1) parent, Parent #2 (P2) made a comment about diaper changing and how they had issues before when their child was transitioning between diaper and potty training.

Records Review: On 11/14/2023, LPA received several documents from RP such as Patient Discharge Summary, Ambulance Report, Medical Report, and Health follow up check-up for C1.

Based on LPA’s observations, record reviews and conducted interviews, the preponderance of evidence standard has been met, therefore the above allegations alleging (1) Staff did not seek medical attention in a timely manner (2) Staff did not follow the child’s medication plan, is found to be SUBSTANTIATED. A substantiated finding means that the complaint is substantiated, and the allegation is valid because the preponderance of the evidence standard has been met.

In the areas evaluated, 1 Type A and 1 Type B deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. Type A violation on section 101226 (c) Health Related Services and a type B violation on section 101226(e)(3)(A) Health Related Services are being cited on the attached LIC9099D.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20231103161859
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: FUN 4 KIDS PRESCHOOL
FACILITY NUMBER: 304370734
VISIT DATE: 12/19/2023
NARRATIVE
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Also, LPA Chan informed the Director Melissa Wojick to provide a copy of this licensing report dated 12/10/2023 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 conducted with Director, Melissa Wojick. The Notice of Site Visit was posted during the visit. The 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. The director was provided with a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First-level appeals should be sent to the Regional Manager to the address listed above.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4