<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 147700023
Report Date: 09/13/2021
Date Signed: 09/14/2021 07:38:26 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/10/2021 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20210910130112

FACILITY NAME:A Little Place for Little PeopleFACILITY NUMBER:
147700023
ADMINISTRATOR:Cynthia WahrenbrockFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 872-1998
CITY:BishopSTATE: ZIP CODE:
93514
CAPACITY:14CENSUS: 5DATE:
09/13/2021
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Cynthia WahrenbrockTIME COMPLETED:
03:52 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is having children’s parents submit opt out of mask mandate forms.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/13/2021, Licensing Program Analyst (LPA) Carol Heath initiated a complaint investigation at the A Little Place for Little People and met with the Licensee Cynthia Wahrenbrock. The purpose of the inspection was to inform the Licensee that an investigation is being conducted regarding the above allegation. The Licensee is having children’s parents submit opt-out of mask mandate forms.There are 5 childcare children present.
During the inspection, LPA interviewed the licensee why she had the parents sign opt-out of mask mandate forms. According to the licensee, she had hard time to ask children to put the mask on. So she asked all the parents to sign the paper. LPA also reviewed 3 children's files and it all incoulded "Consent Form to OPT out of Face mask requirement".
Based on interviews and file reviewed, The preponderance of evidence has been met, Therefore the above allegation is Substantiated
Deficiency cited. Type “B” California Code of Regulation, Title 22, Division 12 Chapter 1 Article 06.
Exit interview conducted and a copy of this report, a notice of site inspection, and appeal rights
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 12-CC-20210910130112
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: A Little Place for Little People
FACILITY NUMBER: 147700023
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
09/27/2021
Section Cited
HSC
1596.885(c)
1
2
3
4
5
6
7
Health and Safety Code Section 1596.885(c): Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the
facility or the people of this state.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The licensee refuse to provide Plan of Correction
8
9
10
11
12
13
14
On 09/13/2021 Based on interviewwith Licensee and 3 file review, the LPA found "opt-out of mask mandate form" in children's file, which poses a potential Health and Safety risk 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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3