304371652-12-2-2025-06-CC-GLUO-DNYV2K-20251202150315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371652
Report Date: 12/02/2025
Date Signed: 12/02/2025 03:03:32 PM

Document Has Been Signed on 12/02/2025 03:03 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:	TRF ST. PETER		FACILITY NUMBER:	304371652
ADMINISTRATOR/ DIRECTOR:	MOLINA, BRISEIDA		FACILITY TYPE:	850
ADDRESS:	1510 NORTH PARTON		TELEPHONE:	(714) 804-5595
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92706
CAPACITY: 29	TOTAL ENROLLED CHILDREN: 29	CENSUS: 21	DATE:	12/02/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:15 PM
MET WITH:	Director Briseda Molina		TIME VISIT/ INSPECTION COMPLETED:	03:15 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	(Page 1) Licensing Program Analyst (LPA) Giselle Lucero conducted an unannounced case management inspection in response to a self-reported Unusual Incident dated October 03, 2025. During the inspection, LPA met with Director Briseida Molina and observed a total of 21 preschool children and 5 staff members in the classrooms. A review of staff criminal clearance 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 or exemptions. On October 3, 2025, the facility submitted a self-reported Unusual Incident Report (UIR) to the Licensing Office. The report indicated that, according to a doctor’s evaluation received on Monday, September 29, 2025, Child #1 (C1) was diagnosed with a dislocated shoulder. Staff were unable to determine how the injury occurred. The facility further reported that upon reviewing surveillance footage to identify the cause of C1’s injury, Staff #3 (S3) was observed excessively handling Child #2 (C2). LPA conducted interviews with facility staff. Staff reported that on Wednesday, September 24, 2025, after returning indoors from outdoor play, C1 appeared to be in discomfort and was holding their arm. Due to C1’s limited verbal abilities, staff were unable to determine the source of pain. Staff observed two mosquito bites on C1’s arm and assumed the discomfort was caused by the bites. C1 was monitored, C1 later developed a mild fever, and the parent was contacted to pick up the child. Staff advised the parent to seek medical attention. In the interim, Director requested that upper management review facility camera footage to determine C1’s injury. (continue to page 2)

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

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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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: TRF ST. PETER	FACILITY NUMBER: 304371652
	VISIT DATE: 12/02/2025

NARRATIVE

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(Page 2)
On Monday, September 29, 2025, the parent provided a doctor’s note confirming that C1 had suffered a dislocated shoulder. Upper management was then asked to review the video footage in detail to identify a possible cause, as staff remained uncertain how the injury occurred. Director reported that they noted in the video footage, C1 had been seen falling at one point, and it was assumed that the fall may have caused the injury. The Director stated that no after-care instructions were provided from the doctor, nor was an arm sling or cast applied to the child. The Director further reported that the child has been behaving normally, as though no injury had occurred.

LPA was provided with a copy of the doctor’s report. Report indicated that C1 was diagnosed with a radial head subluxation, which is a partial dislocation of the radial head bone in the elbow joint.

LPA attempted to interview C1; however the child did not qualify for an interview.

Staff also disclosed that while reviewing the video footage, on the same day of the incident, Wednesday, September 24, 2025, it was observed that S3 was excessively handling C2. Staff described that it occurred during outdoor play, C2 was seen approaching S3 and S3 was seen repeatedly grabbing C2’s arms and sitting C2 on the ground. Management noted that C2 did not appear to be engaging in any concerning behavior prior to S3’s actions and was uncertain why S3 responded in this manner. Following this observation, S3 was placed on a Performance Improvement Plan (PIP) to address supervision practices and appropriate child-handling techniques. Staff did not express any concerns regarding S3’s behavior towards children.

During LPA’s interview with S3, S3 explained that C2 exhibits challenging behaviors and had recently had their Applied Behavior Analysis (ABA) therapy sessions end. S3 stated that they were unsure how to appropriately manage C2’s behavior and reported following instructions previously given by the ABA therapist, specifically, to seat C2 if the child approached them to prevent being bitten or hit. S3 emphasized that their actions were based on this guidance, S3 shared they did not feel supported by management and had not received training on how to appropriately handle children with challenging behaviors.

LPA unable to interview C2 due to C2 no longer attending at the facility.
(continue to page 3)

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

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: TRF ST. PETER	FACILITY NUMBER: 304371652
	VISIT DATE: 12/02/2025

NARRATIVE

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(Page 3)
LPA requested to review the facility’s video footage of the two (2) incidents; however, the facility’s IT department stated that the footage was not retained in time, and therefore the video files are no longer available. As a result, LPA was unable to review the video footage.

Based on the reported incidents and staff interviews, it has been determined that there was a lack of supervision, as staff were unaware of the cause of C1’s injury. Additionally, a personal rights violation was identified due to S3’s excessive handling of C2.

There for 2 Type A deficiencies were observed. The following violations regarding the responsibility for providing care and supervision and personal rights were identified and is being cited pursuant to California Code of Regulations, Title 22, Division 12, Chapter 1, Responsibility for Providing Care and Supervision 101229(a)(1) and Personal Rights 101223 (a)(3); please refer to the attached LIC 809D form.

LPA Lucero informed Director Briseida Molina that this report dated 12/02/2025 document(s) 2 Type A citations 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 Briseida Molina to provide a copy of this licensing report dated 12/02/2025 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 was conducted. The Notice of Site Visit was posted. Director Briseida Molina was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.

End of Report.

NAME OF LICENSING PROGRAM MANAGER: Martha Malane
NAME OF LICENSING PROGRAM ANALYST: Giselle Lucero
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/02/2025 03:03 PM - It Cannot Be Edited

Created By: Giselle Lucero On 12/02/2025 at 01:55 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: TRF ST. PETER	FACILITY NUMBER: 304371652
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/02/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/02/2025 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time....Supervision shall include visual observation.	1 2 3 4 5 6 7	Director stated staff meetings are conducted to provide staff with guidance on superivison. Director stated they will provide a copy of agenda and staff sign in for the December meeting.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews, documents and reported incident, the licensee did not comply with the section cited above. Staff are unaware of the cause of C1's injury. This poses/posed an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type A 12/02/2025 Section Cited CCR101223(a)(3)	1 2 3 4 5 6 7	101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain...	1 2 3 4 5 6 7	Director stated S3 no longer works at the facility however monthly staff meetings are conducted to provide staff with guidance on how to handle children with challenging behaviors. Director stated they will provide a copy of agenda and staff sign in for the December meeting.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews and reported incident, the licensee did not comply with the section cited above. S3 was observed excessively handling C2. This poses/posed an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Martha Malane
NAME OF LICENSING PROGRAM MANAGER:

	Giselle Lucero
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025

LIC809 (FAS) - (06/04)

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