304370915-9-11-2024-06-CC-THOO-D9QKYC-20241004081854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370915
Report Date: 09/11/2024
Date Signed: 09/11/2024 11:27:23 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 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
08/05/2024 and conducted by Evaluator Mahnaz Malek

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20240805145341

FACILITY NAME:	LIFE TIME ATHLETIC-LAGUNA		FACILITY NUMBER:	304370915
ADMINISTRATOR:	DELGADILLO, SUSANA		FACILITY TYPE:	840
ADDRESS:	25600 RANCHO NIGUEL ROAD		TELEPHONE:	(949) 238-2700
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	100	CENSUS: 0	DATE:	09/11/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Director, Susana Delgadillo		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Lack of supervision resulting in daycare children engaging in an altercation.
Staff did not seek medical attention for daycare child.
Staff did not provide daycare child with appropriate sleeping accommodations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted a follow up investigation regarding the above allegations. This is a follow up for the visit conducted on 8/7/2024. LPA met with director, Susana Delgadillo. This camp program is currently closed during school year except for the School Holidays. On this inspection, there were no children present in the camp program. A review of staff records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On 8/5/2024, the Orange County Childcare Office received a complaint alleging “Lack of supervision resulting in daycare children engaging in an altercation”. ‘Staff did not seek medical attention for daycare child” and “Staff did not provide daycare child with appropriate sleeping accommodations”. Per reporting party (RP) during attending Summer Camp on 7/24/2024 at pick up time, it was observed 6-year-old Child # 1 (C1) was asleep on the hard wood floor in the Member Activity Room. When asked, was told C1 has been sleeping there for hours since lunch and C1 would be upset if disturbed. R/P stated when asked if medical
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20240805145341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LIFE TIME ATHLETIC-LAGUNA	FACILITY NUMBER: 304370915
	VISIT DATE: 09/11/2024

NARRATIVE

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attention received, the staff replied "No". R/P questioned the staff why C1 sleeping for hours, and had not been screened by medical personnel, and no parent notification was made? C1 disclosed that they had an altercation with another child, and C1 was pushed onto the ground impacting C1’s head.
During the course of investigation, LPA interviewed 11 staff, 8 children including C1, and 10 parents of whom one parent responded.
During interviews with 11 staff, staff # 3 stated on 7/24/2024 they were in the basketball court playing with another child. S3 stated they saw C1 was on the floor in the basketball court. S3 found out they were fighting over a ball. (Tiger ball with handle). S3 applied ice pack on the back of C1’s head. S3 stated they reminded C1 to keep ice pack on. S3 did not notify the management of this incident and did not check back with C1 to see how C1 was doing. S3 stated they wrote an incident report electronically assuming management would be notified. S5 stated they saw C1 sitting in the corner of basketball court telling S5 that their legs were tired and was trying to fall asleep on the gym floor in the basketball court. S5 stated this was reported to S1 on the walkie talkie. S1 came and walked C1 to Members Activity Room. S5 stated C1 slept for 20 minutes after lunch. S6 stated they observed C1 was hit by a basketball in the head accidentally around 10:30 am in the basketball court. An incident report was not issued and was not reported to management since the child was fine. S6 stated they left early on that day around 2:00 pm.
S7 stated they were in the room when C1 was picked up. They came from the gym to the Member Activity Room at 4:00 pm. S7 stated they noticed C1 was very tired. C1 would be cranky when staff trying to wake C1 up. S7 stated they would have called 911 if C1 had not been feeling well. C1 seemed fine breathing normal. S7 stated they saw C1 in the gym by the wall laying down (sleeping) using their backpack as a pillow. Management was notified. S1 came around 4:00 pm and walked C1 to the Member Activity Room. S7 stated they did not know C1 had fallen on the back of the head earlier on that day.
S10 stated they were in the room when C1 was picked up. S10 had just arrived the room when C1 was picked up in the Members Activity Room. S10 stated they saw C1 on the floor. S10 stated they had seen C1 during the day in the Rock Wall area around 2:00pm. During walkie talkie conversation, S10 had heard staff reported C1 was tired and sleepy but S10 did not follow to see if a manager called C1’s parent. C1 was picked up upon S10’s arrival. The rest of the staff did not acknowledge observing any incident regarding C1. The staff stated they supervise children, and they report any incidents to their supervisor. However, the incidents regarding C1 was not reported to the management on 7/24/24.
S1 stated they remember they were told C1 was very tired and sleepy. S1 stated they were going to call C1’s
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SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20240805145341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LIFE TIME ATHLETIC-LAGUNA	FACILITY NUMBER: 304370915
	VISIT DATE: 09/11/2024

NARRATIVE

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representative but they got distracted by something else. S1 stated they had not been notified of an incident of C1 was hit by a basketball on the head accidentally and another incident of falling back on the head on that day. S3 wrote and incident report for the fall but did not report the incident to S1.
LPA also interviewed 8 children including C1. C1 stated that they were in the basketball court, and they were trying to throw a ball. Another child had the ball already and C1 tried to grab it. C1 stated they tried to get C1 off. C1 held on tight to the ball that another child was holding. Someone (unknown) pushed C1 and C1 fell backwards on the head. C1 stated when C1 fell, everyone helped C1. C1 stated only S3 put ice pack on the back of their head. C1 could not mention any other staffs' names. C1 stated C1 was so tired. C1 used their jacket to try to sleep in the basketball court. Other children did not acknowledge observing any incidents. C3 stated they observed C1 laying on the floor in the Members Activity Room. Children stated the staff supervise them. The duration of C1’s sleeping is not exactly determined. However, it is confirmed that C1 has been sleeping in the basketball court here and there and in the Members Activity Room for 20 minutes.
During the course of interviews with 11 staff, 8 children, and 10 parents of whom one parent responded with no concerns, it was determined the preponderance of evidence standard have been met, the allegations of "Lack of supervision resulting in daycare children engaging in an altercation”, "staff did not seek medical attention for daycare child", and "staff did not provide daycare child with appropriate sleeping accommodations" are found to be SUBSTANTIATED. Please refer to 9099Ds next page for citation issued.
California Title 22 Regulations Section 101229, 101226(a), and 101226(1) are cited on 9099D next page. The director, Susana Delgadillo was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Notice of Site Visit must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00. LPA Malek informed the director, Susana Delgadillo that this report dated 9/9/2024 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care. Also, LPA Malek informed the director, Susana Delgadillo to provide a copy of this licensing report dated 9/9/2024 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. The director, Susana Delgadillo, was provided with 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. The exit interview was conducted with director, Susana Delgadillo.
End of reports.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20240805145341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LIFE TIME ATHLETIC-LAGUNA	FACILITY NUMBER: 304370915
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/12/2024 Section Cited CCR 101229(a)	1 2 3 4 5 6 7	The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by a complaint report, and interviews, that C1 was hit on the head by a basketball accidentally but staff did not provide supervision continuously on C1 for	1 2 3 4 5 6 7	The director will send a statement that they will train the staff on supervision of children at all times and on the incident occasions by the due date of 9/13/2023 on the next date that facility re-opens on (Public School Holidays).
	8 9 10 11 12 13 14	the wellness since it was a head injury. On the same date of 7/24/24 C1 and another child were fighting over a ball. Staff did not intervene to prevent the altercation and did not provide supervision on the C1’s wellness since this incident was head injury. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	The director will follow up with staff watch the videos regarding supervision of children at the Department's website of: https://ccld.childcarevideos.org/child-care-center-operators/childrens-supervision-in-child-care The proof of watching the videos will be sent to LPA once facility re-opens.
Type A 09/12/2024 Section Cited CCR 101226(a)	1 2 3 4 5 6 7	Health Related Services- The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken. This	1 2 3 4 5 6 7	The director agreed to send an acknowledgment statement to LPA's email address by the due date of 9/13/2024 that they are aware of this section of regulations and the procedures of the communications internally which will be discussed with staff
	8 9 10 11 12 13 14	This requirement was not met as evidenced by staffs' interviews that C1 fell backwards on the head. C1 was tired and sleepy during the day. Ice pack applied. Child’s representative was not notified. This is an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	once the facility re-opens on (Public School Holidays).

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 Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 06-CC-20240805145341

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: LIFE TIME ATHLETIC-LAGUNA	FACILITY NUMBER: 304370915
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/12/2024 Section Cited CCR 101226(1)	1 2 3 4 5 6 7	Health Related Services- In the case of an illness severe enough to require isolation of the child, the center shall follow the procedures specified in Section 101226.2. This requirement was not me as evidenced by interviews that the C1 fell on back of the head. Child was tired and sleepy	1 2 3 4 5 6 7	The director agreed to send a statement that they are aware of an arrangements and a plan to provide sleeping accommodations or isolation area for the illness and occasions such as the incident happened on 7/24/2024.
	8 9 10 11 12 13 14	tired and sleepy during the day. Child was sleeping on the bare floor of the basketball court and in the Member’s Activity Room on the hard wood floor for approximately 20 minutes on different timing. This is a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Ho	TELEPHONE: (714) 703-2741
LICENSING EVALUATOR NAME: Mahnaz Malek	TELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC9099 (FAS) - (06/04)

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