304371251-4-4-2024-06-CC-AFCN-D3ZU4B-20240404151453

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371251
Report Date: 04/04/2024
Date Signed: 04/04/2024 03:14:58 PM

Document Has Been Signed on 04/04/2024 03:14 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:	CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCH		FACILITY NUMBER:	304371251
ADMINISTRATOR:	WELCH, AMBER		FACILITY TYPE:	830
ADDRESS:	20400 FAIRMONT CONNECTOR		TELEPHONE:	(714) 290-3993
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	19	CENSUS: 6	DATE:	04/04/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Director Amber Welch		TIME COMPLETED:	03:30 PM

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On 04/04/24 at 2pm, a case management inspection was conducted today by Licensing Program Analyst (LPA) Anna Chan who met with the Director, Amber Welch. LPA was led on a tour of the facility. There were 3 staff present and 6 infants in care. A self-reported incident by the facility was received at the regional office on 11/27/23 which stated that child #1 (C1) sustained 2^nd degree burn from spilling hot water from the bottle warmer.

A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Based on staff interview, Staff #1 (S1) stated that on 11/27/23, while carrying C1, S1 sat C1 on the counter and grabbed the warmed milk bottle, the bottle warmer with water tipped over and spilled hot water. C1 started to cry and S1 realized that the hot water went to C1’s legs. S1 immediately removed C1s pants and placed C1s legs on running water and called emergency services.

Parent #1 (P1) stated that C1 sustained burns and was instructed by the physician to continue to wrap the child’s legs and apply burn cream. P1 stated they are not upset for what happened and the facility did the right thing to call the paramedics right away.

Based on LPA’s observation on 01/18/24, there were scattered reddish burn marks on the right and left inner thigh and back of left knee of C1. Photos were taken during the observation.

LPA received medical report from the Emergency Medical Services (EMS), the report stated that EMS continued to monitor child until transported to the hospital. The medical report indicates that the child sustained hot water scald burns to bilateral lower extremities that child sustained burns. Patient was given burn dressing and topical meds for burns. Patient was discharged the same day on 11/27/23.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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: CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCH	FACILITY NUMBER: 304371251
	VISIT DATE: 04/04/2024

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Based on LPA’s interviews, observations and records reviewed, the facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following violations was cited, 1 Type A was issued today on the attached LIC 809D.

LPA informed Director, Amber Welch that this report dated 04/04/24 documents 1 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 informed the Director, Amber Welch to provide a copy of this licensing report dated 04/04/24 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.

Exit interview conducted and report was reviewed with the Director, Amber Welch. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal Rights and deficiencies were discussed. The facility representative was provided 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.

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SUPERVISOR'S NAME: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/04/2024 03:14 PM - It Cannot Be Edited

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: CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCH	FACILITY NUMBER: 304371251
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/04/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/05/2024 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The director stated the bottle warmers were replaced with new ones and the bottle warmers are placed inside a bucket for safety. A staff training was done about feeding and not holding a baby while preparing food or retrieving bottle from warmer. A signed copy of the training will be provided to the LPA by due date of 4/5/24
	8 9 10 11 12 13 14	Based on the information gathered from the interviews conducted, medical reports, photos and observation, It was determined that C1 sustained 2nd degree burns on both legs due to hot water spilling on a counter and onto C1 which pose an immediate risk to the health and safety of the children in care.	8 9 10 11 12 13 14	Director stated that a copy of ouch report and a documented write-up for S1 will be made and a copy of signed document will be provided to LPA by due date.
	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: Martha Malane	TELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Anna Francesca Chan	TELEPHONE: (818) 216-9775
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC809 (FAS) - (06/04)

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