304371214-9-27-2023-06-CC-NKTN-CW3US8-20230927154956

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371214
Report Date: 09/27/2023
Date Signed: 09/27/2023 03:50:03 PM

Document Has Been Signed on 09/27/2023 03:50 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	LEPORT-IRVINE SPECTRUM-NORTH CAMPUS		FACILITY NUMBER:	304371214
ADMINISTRATOR:	BARTOLOME, KRISTA		FACILITY TYPE:	850
ADDRESS:	1 TECHNOLOGY DRIVE BLDG. A		TELEPHONE:	(949) 427-3968
CITY:	IRVINE	STATE: CA	ZIP CODE:	92618
CAPACITY: 119	TOTAL ENROLLED CHILDREN: 119	CENSUS: 76	DATE:	09/27/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Krista Bartolom, Director		TIME COMPLETED:	01:00 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 Analyst (LPA) Tran conducted a case management inspection to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 09/25/2023. It was reported by Krista Bartolom, Director. According to the Director, the unusual incident occurred on 09/25/2023 at approximately 11:20am in Birch classroom. During the transition to the playground, staff #1 (S1) and staff #2 (S2) completed face-to-name count at 11:20am, however, at 11:45am, staff were not able to locate Child #1 (C1) on the playground. Staff informed management team over the radio. At 11:50am, Staff #3, who was delivering the lunches to the classrooms, found C1 in the Birch classroom's bathroom and C1 was crying. C1 was brought to the front office. Director met with C1 and C1 was later returned to the playground. C1's parent was notified of the incident and Director met with the staff to address concerns of supervision during transition. During today's inspection a tour of the facility was conducted. There were 67 children including 21 toddlers were supervised by 10 staffs in 5 different classrooms. A review of staff 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. During today's inspection, staff members were interviewed. S1 stated there were 16 children present, on the day of the incident, with two staff supervising. S1 stated the class went outside to the playground at approximately 11:15 a.m. S1 reported the children lined up to go outside to the playground, S1 was in the front of the line and S2 was in the back of the line. S1 stated S1 conducted face-to-name count using the Tadpole app and accounted for all the children before leaving the classroom to transition to the playground. According to S1, S2 was at the end of the line and was supposed to ensure all the children transitioning outside of the classroom before closing the classroom door. Usually, S1 will conduct another count when the class completed the transition into the playground but there was a change in schedule so another preschool classroom was utilizing the playground and there were many children present. S1 completed another face-to-name count at approximately 11:45am and was not able to locate C1 on the playground. The Admin team was informed and the S3 located C1 in the restroom of the Birch classroom. (Continue next page)

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LEPORT-IRVINE SPECTRUM-NORTH CAMPUS	FACILITY NUMBER: 304371214
	VISIT DATE: 09/27/2023

NARRATIVE

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(Page 2 of Report)

S3 and Director were also interviewed during today inspection and provided consistent details of the incident.
Based on LPA’s interviews conducted with staff, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision. The deficiency is being cited on the attached 809D.

If the facility receives a Type 'A' violation the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. The licensee is to keep Acknowledgement Receipt (LIC9224) signed by parents in each child’s file.

Appeal Rights and deficiency were explained. The Director was provided a copy of 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. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Krista Bartolom .

SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/27/2023 03:50 PM - It Cannot Be Edited

Created By: Nguyen K Tran On 09/27/2023 at 12:52 PM

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 SPECTRUM-NORTH CAMPUS	FACILITY NUMBER: 304371214
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/02/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time... This requirement is not met evidenced by	1 2 3 4 5 6 7	Director states that facility has addressed concern and took appropriate discipline action to correct the issue. Staff will be retraining on suppervision procedures with additional measures being implemented to ensure all children are accounted for during transition.
	8 9 10 11 12 13 14	Based on interviews with staff #1, #3, and Director, C1 was left unsupervised in the classroom for approximately 30 minutes. This poses an immediate risk to the safety of children in care.	8 9 10 11 12 13 14	Director will submit proof of staff retraining to LPA by 10/02/2023
	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:

Judy Hanson

LICENSING EVALUATOR NAME:

Nguyen K Tran

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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