153801077-11-10-2021-12-CC-CBEL-C92UUP-20211123145352

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 153801077
Report Date: 11/10/2021
Date Signed: 11/10/2021 05:57:30 PM

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
08/30/2021 and conducted by Evaluator Isabel Ortega

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20210830105059

FACILITY NAME:	GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER		FACILITY NUMBER:	153801077
ADMINISTRATOR:	ARNECKE, KRISTEN		FACILITY TYPE:	850
ADDRESS:	329 S. MILL ST.		TELEPHONE:	(661) 823-7740
CITY:	TEHACHAPI	STATE: CA	ZIP CODE:	93561
CAPACITY:	64	CENSUS: 37	DATE:	11/10/2021
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Kristen Arnecke		TIME COMPLETED:	05:49 PM

ALLEGATION(S):

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Allegation #1: Personal Rights: Facility failed to report a COVID-19 positive at the facility
Allegation #2: Personal Rights: Facility failed to quarantine children who were exposed to a COVID-19 positive at the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Isabel Ortega conducted a subsequent complaint inspection at the facility for the purpose of delivering the findings of the above allegation. Upon arrival 37 children were present and 8 Staff. LPA announced the purpose of the inspection and was granted entry to the facility.

During this investigation LPA interviewed Staff, children and parents. Based on interviews with all parties involved and record review, the facility did not report a positive Covid -19 testing result and did not quarantine possible exposed children and Staff in August 2021. The interviews revealed disclosure of no knowledge of a positive covid-19 result. Interviews also revealed facility did not quarantine possible exposures in August.2021.

These allegations #1: Personal Rights: Facility failed to report a COVID-19 positive at the facility and Allegation #2: Personal Rights: Facility failed to quarantine children who were exposed to a COVID-19 positive at the facility are deemed to be SUBSTANTIATED and a citation will be issued.(See LIC 9099-D for cited deficiency). Continue on next page

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 12-CC-20210830105059

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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER	FACILITY NUMBER: 153801077
	VISIT DATE: 11/10/2021

NARRATIVE

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A finding of substantiated means that the allegations were valid because the preponderance of the evidence standard has been met. This facility was cited a Type B in accordance to Title 22 of the California Code of Regulations and Health & Safety codes.

An exit interview was conducted with Director, a copy of this report was provided along with the appeal rights and Notice of Site Visit.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 12-CC-20210830105059

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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER	FACILITY NUMBER: 153801077
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/10/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/11/2021 Section Cited CCR 1012232(a)(2)	1 2 3 4 5 6 7	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 by interview disclosures obtained by relevant parties disclosing a positive Covid-19 result was not reported and facility did not quarantine possible exposed children nor staff.	1 2 3 4 5 6 7	Facility stated immediately all positive covid testing results will reported to possible exposed Staff and parents, Department of Public Health(DPH) and CCL. Facility will follow DPH's recommendations. Facility will also keep record of notes when children are send home due to illness.
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
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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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC9099 (FAS) - (06/04)

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