DOLPHIN CLUB DAY CARE CENTER, THE

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Vivian Trinh conducted an on-site inspection for a self reported incident on 4/4/2025. The Director, Gonzales, Kari, was informed of the purpose of the visit, and a tour of LPA around the center was completed. The census included 4 school-age children and 3 staff members A review of the Facility Personnel Report Summary conducted on today’s date 5/22/2025 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 4/8/2025, an Unusual Incident Report was filed with the Department to self-report an incident that occurred on 4/4/2025. It was reported that Child #1 (C1) exhibited inappropriate behaviors toward other children in the classroom, and the facility had taken actions to address concerns about the child’s appropriate behavior. During the investigation, LPA interviewed five (5) staff members and two (2) children and obtained a copy of the children's roster, LIC 500, Parents Handbook, facility roster, and the email communication with parents. LPA interviewed five (5) staff members. All staff members stated that they did not witness the incident in which C1 exhibited inappropriate behaviors toward other children in the class. However, when facility staff was informed of the incident by Child #2 (C2)’s parent, the Director conducted an internal investigation, interviewed staff and children, informed the involved parents, and suspended C1 until further notice. Continued page 2. NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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 fac

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) Vivian Trinh conducted an on-site inspection for a self reported incident on 4/4/2025. The Director, Gonzales, Kari, was informed of the purpose of the visit, and a tour of LPA around the center was completed. The census included 4 school-age children and 3 staff members A review of the Facility Personnel Report Summary conducted on today’s date 5/22/2025 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 4/8/2025, an Unusual Incident Report was filed with the Department to self-report an incident that occurred on 4/4/2025. It was reported that Child #1 (C1) exhibited inappropriate behaviors toward other children in the classroom, and the facility had taken actions to address concerns about the child’s appropriate behavior. During the investigation, LPA interviewed five (5) staff members and two (2) children and obtained a copy of the children's roster, LIC 500, Parents Handbook, facility roster, and the email communication with parents. LPA interviewed five (5) staff members. All staff members stated that they did not witness the incident in which C1 exhibited inappropriate behaviors toward other children in the class. However, when facility staff was informed of the incident by Child #2 (C2)’s parent, the Director conducted an internal investigation, interviewed staff and children, informed the involved parents, and suspended C1 until further notice. Continued page 2. NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran NAME OF LICENSING PROGRAM ANALYST: Vivian Trinh LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/22/2025 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2025 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 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 fac

Type B citation - potential risk if not corrected