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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371581
Report Date: 06/21/2024
Date Signed: 06/21/2024 01:25:41 PM

Document Has Been Signed on 06/21/2024 01:25 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:PIPER IRVINE LLC.FACILITY NUMBER:
304371581
ADMINISTRATOR/
DIRECTOR:		SIEM, CLAUDIAFACILITY TYPE:
850
ADDRESS:8673 IRVINE CENTER DRIVETELEPHONE:
(310) 451-4600
CITY:IRVINESTATE: CAZIP CODE:
92618
CAPACITY: 185TOTAL ENROLLED CHILDREN: 185CENSUS: 75DATE:
06/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Director Rainbow Ortiz TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
NARRATIVE
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(Page 1)
On 06/21/2024, Licensing Program Analyst (LPAs) Giselle Lucero conducted a Case Management due to deficiencies observed during today's visit.

A review of staff criminal clearance records indicated that 2 staff members that were observed in the classrooms did not obtain a criminal record clearance prior to their initial presence in the facility. LPA reviewed the Guardian Employee Roster and the individual, Emily Mohr, stated "In process". Emily Mohr is pending fingerprint clearance and has been working at the facility since 11/27/2023. During review of the Guardian Employee roster, LPA did not observe an application was submitted for Chloe Lin. Director provided a copy of request for live scan form for Chloe Lin. Form stated live scan for Chloe Lin was conducted on 09/08/2023, however there is no profile on Guardian for Chloe Lin. Director stated they will call the company where the live scan was completed to figure out if the fingerprint results were submitted. Chloe Lin has been working at the facility since 10/27/2023. Director was unable to provide proof of fingerprint clearances for the 2 individuals. This is a violation of Title 22 Division 12 Chapter 1 Article # 3 Section 101170(d)(2). A civil penalty of $1000 will be assessed today.

Director immediately had Chloe Lin and Emily Mohr leave the premises and stated they will have Chloe and Emily return once criminal record clearances have been obtained.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

(Continue to Page 2)
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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 3
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: PIPER IRVINE LLC.
FACILITY NUMBER: 304371581
VISIT DATE: 06/21/2024
NARRATIVE
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(Page 2)
Therefore, in the areas that were inspected, one Type A deficiency was observed of the California Code of Regulations, Title 22, Division 12 Section 101170 (d)(2) Criminal Record Clearance, at the time of the visit. See attached LIC809D.

LPA Lucero informed Director Rainbow Ortiz that this report dated 06/21/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Lucero informed Director to provide a copy of this licensing report dated 06/21/2024 that documents any Type A citation(s) 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. 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.

End of Report.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Giselle Lucero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/21/2024 01:25 PM - It Cannot Be Edited


Created By: Giselle Lucero On 06/21/2024 at 12:54 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: PIPER IRVINE LLC.
FACILITY NUMBER: 304371581

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2024
Section Cited
CCR
101170(d)(2)

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101170 Criminal Record Clearance: (d) All individuals subject to criminal record review shall, be fingerprinted...of perjury. (2) The licensee...prior to the individual's employment or initial presence in the child care facility. This requirement was not met as evidenced by: Emily Mohr and Chloe Lin did not obtain
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Director immediately had Chloe Lin and Emily Mohr leave the premises and were sent to complete their finger prints. Director stated they will have Chloe and Emily return once criminal record clearances have been obtained.
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a criminal record clearances prior to their initial presence in the facility and have been working since 09/08/2023 and 10/27/2023. This is an immediate health and safety and personal rights risk to the children in care. Civil penalty of $1000 was assessed.
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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.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Giselle Lucero
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2024


LIC809 (FAS) - (06/04)
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