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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371210
Report Date: 05/09/2025
Date Signed: 05/09/2025 10:41:15 AM

Document Has Been Signed on 05/09/2025 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEPORT-IRVINE WOODBRIDGEFACILITY NUMBER:
304371210
ADMINISTRATOR/
DIRECTOR:		ROTENBERRY, CHRISTINE LINFACILITY TYPE:
850
ADDRESS:26 LAKE ROADTELEPHONE:
(949) 551-9020
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY: 118TOTAL ENROLLED CHILDREN: 46CENSUS: 0DATE:
05/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Head of Schools-Christine, RotenberryTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
NARRATIVE
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On 5/09/2025 an unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Karen Navar in response to a self-reported incident dated 4/14/2025. Present during today’s inspection was Head of Schools Christine, Rotenberry. Christine stated today is staff development and there are no children here today. LPA did not observe any children on site in day-care.

A review of adult records 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 Department received an incident report on 04/14/2025 stating that on 04/14/25 at 9:50AM Staff 1 (S1) applied a lotion labeled with another child’s name to Child #1 (C1). C1 then began swelling and Staff 2 (S2) called 911 and the parents.

During the investigation LPA toured the facility on 4/16/2025 with Head of Schools and observed stored medication/lotions in Room 2s cabinet. During observations children were listening to a story in the carpet area. LPA interviewed three staff, two of the staff interviewed were supervising children on the day of the incident. Three staff stated that C1 came to S1 after eating a tropical fruit snack stating they were itchy under their eyes and elbow area. Three staff stated that S1 then applied a very small amount of another child’s topical lotion to C1 and that C1 then began swelling so they called 911 and the parents. Three staff stated that C1 has no known allergies reported to them and that they keep an allergy list of children’s names on a clip board in the classroom. Three staff interviewed stated that medication and lotion labeled with child’s name is stored in the classroom cabinet with the plan and parent/guardian consent form.

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NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Karen Navar
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEPORT-IRVINE WOODBRIDGE
FACILITY NUMBER: 304371210
VISIT DATE: 05/09/2025
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During today’s visit 5/09/2025 LPA reminded S2 of Title 22 Regulation Health-Related Services 101226 (B) For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child’s authorized representative for the administration of the medication to the child. LPA provided a copy of regulation to Head of Schools Christine, Rotenberry.

Based on the information gathered from the interviews with staff and records reviewed. The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation Health-Related Services 101226(B) was issued today. See the attached LIC 809D.

LPA Navar informed Head of Schools Christine, Rotenberry that this report dated 05/09/2025 documents a 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 Navar informed the director Christine,Roenberry to provide a copy of this licensing report dated 05/09/2025 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 the Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the children's files for verification.

Exit interview conducted and report was reviewed with the Head of Schools Christine, Rotenberry. A notice of site visit was given and must remain posted for 30 days. Failure to post will result in civil penalties of $100.



End of report.
NAME OF LICENSING PROGRAM MANAGER: Thuy Ho
NAME OF LICENSING PROGRAM ANALYST: Karen Navar
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/09/2025 10:41 AM - It Cannot Be Edited


Created By: Karen Navar On 05/09/2025 at 09:46 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: LEPORT-IRVINE WOODBRIDGE
FACILITY NUMBER: 304371210

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2025
Section Cited
CCR
101226(B)

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Health-Related Services(B) For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medicaiton to the child. This requirement is not met as evidenced by:
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Head of School reviewed regualtions for applying lotions to children only with that specific childs name on the bottle. Head of Schools provided LPA Navar with a copy.
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Based on record review and 3 staff member interviews. 3 staff members and Unusual Incidnet report dated 4/14/2025. S1 applied a lotion to C1 that was labeled with another childs name that reuslted in facility having to call 911 and parents due to the reaction C1 had from the lotion.
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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.
Thuy Ho
NAME OF LICENSING PROGRAM MANAGER:
Karen Navar
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2025


LIC809 (FAS) - (06/04)
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