103808640-3-7-2022-04-CC-MDUE-CCMNQX-20220318104039

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 103808640
Report Date: 03/07/2022
Date Signed: 03/07/2022 02:54:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/21/2022 and conducted by Evaluator Ruby Ocegueda

PUBLIC

COMPLAINT CONTROL NUMBER: 04-CC-20220121154747

FACILITY NAME:	OUR LADY OF PERPETUAL HELP SCHOOL		FACILITY NUMBER:	103808640
ADMINISTRATOR:	BOUCHARD, JOAN		FACILITY TYPE:	850
ADDRESS:	836 DEWITT AVENUE		TELEPHONE:	(559) 299-7504
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93612
CAPACITY:	26	CENSUS: 11	DATE:	03/07/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Nara Adjemian		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility not following COVID-19 guidelines.

INVESTIGATION FINDINGS:

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On 3/7/2022, Licensing Program Analyst (LPA) Ruby Ocegueda conducted an unannounced complaint inspection at the facility. LPA met with facility Director Nara Adjemian. The purpose of the inspection was to deliver the finding for the above listed complaint allegation. A tour of the facility was conducted, and census was taken.

During the course of the investigation, LPA Ocegueda collected facility records and conducted multiple interviews of the reporting party, staff and parents. Multiple interviews revealed that although the facility is cleaning, disinfecting and washing hands as required, generally, masks were not being worn by children and at times parents entering the facility as was required by the California Department of Public Health (CDPH). In addition, on 1/27/2022, LPA Ocegueda observed that two children were wearing masks inside the facility, while 18 children were not. The facility had nine clean child size masks available that day, not enough for all children in care. Report continued to 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 04-CC-20220121154747

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: OUR LADY OF PERPETUAL HELP SCHOOL	FACILITY NUMBER: 103808640
	VISIT DATE: 03/07/2022

NARRATIVE

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Report continued from previous 9099 page.

Today, LPA reviewed the most current Covid-19 requirements (including reporting requirements for Covid-19 cases involving children and staff) and reminded Director Adjemian that the facility should follow the most current Covid-19 health mandates and guidance set forth by the California Department of Public Health and follow the guidance of the California Department of Social Services. LPA Ocegueda encouraged administrator Dodd to visit the Departments website ccld.ca.gov to review the most recent Provider Information Notices (PINS) that discuss the most current licensing requirements for licensed facilities.

This agency investigated the complaint alleging that "Facility not following COVID-19 guidelines” and this agency has determined that the complaint allegation is SUBSTANTIATED, meaning the preponderance of evidence standard has been met.

Per California Code of Regulations, Title 22, Division 12, Chapter 3, the following deficiency was cited: (see 9099-D). Appeal Rights were provided today. Notice of Site Visit LIC 9213 must be posted for 30 days.

SUPERVISOR'S NAME: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

LIC9099 (FAS) - (06/04)

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Control Number 04-CC-20220121154747

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: OUR LADY OF PERPETUAL HELP SCHOOL	FACILITY NUMBER: 103808640
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/21/2022 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	(a)The licensee shall ensure that each child is accorded the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by: interviews and observation. Multiple interviews revealed that	1 2 3 4 5 6 7	Director stated that a statement would be completed by the facility representative including how the facility will ensure they are up to date on the most current California Department of Public Health (CDPH) mandates and gudiance for child care facilities and how they will implement the requirements in their facility at all times. Proof will be submitted by POC date 3/21/2022.
	8 9 10 11 12 13 14	the facility allowed parents and staff to enter the facility withought a mask on multiple occassions and interviews and observation revealved that the facility did not follow the CDPH requirements on mask wearing for children in care. This poses a potential risk to the health, safety and/or personal rights to children in care.	8 9 10 11 12 13 14
	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: Michael Duarte	TELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby Ocegueda	TELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022

LIC9099 (FAS) - (06/04)

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