304370856-3-3-2023-06-CC-DTHN-CPKSG6-20230303125126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304370856
Report Date: 03/03/2023
Date Signed: 03/03/2023 12:51:32 PM

Document Has Been Signed on 03/03/2023 12:51 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:	MAOF/SSA TUSTIN FAMILY CAMPUS ECEC		FACILITY NUMBER:	304370856
ADMINISTRATOR:	QUINTANILLA, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	15405 LANDSDOWNE ROAD		TELEPHONE:	(714) 566-2870
CITY:	TUSTIN	STATE: CA	ZIP CODE:	92782
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 2	CENSUS: 1	DATE:	03/03/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Elizabeth Quintanilla		TIME COMPLETED:	01:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Dean Thompson and Patricia Duron conducted an unannounced case management incident inspection in response to a self reported Unusual Incident dated 2/28/2023. LPAs met with Director Elizabeth Quintanilla and toured the facility. LPAs observed one preschool age child and two staff. 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 2/28/2023 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported receiving a phone call from a parent asking about marks on their child’s wrist. Parent stated seeing red marks on their child on Wednesday, February 22, while bathing Child (C1). Parent stated asking the child about the red mark and child stated that teacher (S1) had grabbed her hard. On 3/1/2023 LPA interviewed the parent (P1) of child (C1) involved. Parent stated, child had a red mark on the inside of her wrist but couldnt tell if it was a bruise or not. Parent (P1) stated she had a meeting with Director and teacher (S1) and left the meeting with a better understanding. Parent stated she didnt have anything negative to say about the care and supervision the child receives at the facility. During today’s visit on 3/3/2023, LPAs interviewed child (C1) who stated she enjoys coming to school because she like to play and she likes Teacher (S1). Continue to page 2

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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: MAOF/SSA TUSTIN FAMILY CAMPUS ECEC	FACILITY NUMBER: 304370856
	VISIT DATE: 03/03/2023

NARRATIVE

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On 3/3/2023 LPAs interviewed teacher (S1). Teacher stated she was alone with the child on 2/24/2023 and child started throwing dolls, toys and trying to kick. Teacher stated she placed her hands in front of the child to block her from throwing items at her and kicking her. Teacher stated, placing her hands over C1 hands and mentioned to child to use gentle hands and redirecting child.

on 3/3/2023 LPA's interviewed Director. Director stated there was no ouch report or incident report because mom stated the incident happened on February 22, 2023. Teacher and mom had a conversation on February, 22, 2023 and Teacher told mom, child had a great day. The only day teacher observed child having a bad day was on Friday, February 24, 2023 but no injuries occurred. On Tuesday, February 28, 2023 mom called and stated she wanted an incident report dated for February 22, 2023.

Based LPA interview with parent on 3/1/2023 and interviews with Director, staff, and child on 3/3/2023 there was not enough evidence to substantiate child sustaining injuries while in care.

This agency has investigated the self reported Unusual Incident dated 2/28/2023 and there is not enough preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Notice of Site Visit was posted. The notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. The licensee was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. Exit interview was conducted with Director Elizabeth Quintanilla.

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC809 (FAS) - (06/04)

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