191201899-9-18-2020-12-CC-SHEG-BUPPBB-20201024111004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191201899
Report Date: 09/18/2020
Date Signed: 09/18/2020 08:13:03 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
09/18/2020 and conducted by Evaluator Brigitte Tsutaoka

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20200918092540

FACILITY NAME:	LANCASTER UNITED METHODIST CHURCH PRE SCHOOL		FACILITY NUMBER:	191201899
ADMINISTRATOR:	DAMON, TAMMY		FACILITY TYPE:	850
ADDRESS:	918 WEST AVENUE J		TELEPHONE:	(661) 942-0812
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	58	CENSUS: 29	DATE:	09/18/2020
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Director Tammy Damon		TIME COMPLETED:	08:26 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Neglect/Lack of Supervision: Day care child wandered away from the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Mariela Ramon, Licensing Program Manager (LPM) and Brigitte Tsutaoka, Licensing Program Analyst (LPA) met facility director for the purpose of conducting an investigation concerning the above allegation. Upon arrival, LPM and LPA observed 29 preschool children with 7 staff members.

The investigation of the above allegation consisted of interviews with director, staff and other relevant parties. It was revealed that on 09/17/20, Staff #1 was supervising 7 preschool children in the courtyard. Staff #1 was giving child #1 a cup of water. Child #1 walked towards a little Tykes car to get into. Staff #1 turned around to set the pitcher of water down on the bench and by the time Staff #1 turned around, child #1 was not near the little Tykes car. Please see Complaint Investigation Report LIC 9099C for additional information.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

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-20200918092540

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: LANCASTER UNITED METHODIST CHURCH PRE SCHOOL	FACILITY NUMBER: 191201899
	VISIT DATE: 09/18/2020

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
26
27
28
29
30
31
32

Staff #1 notified Staff #2, Staff #3, and Staff #4 and they started looking for Child #1 in the facility. It was determined Child #1 exited the facility from a emergency exit gate (ADA approved) facing Northwest side of the facility. The gate has a doorknob that is located at a child's height. Approximately 8 minutes later, Staff #2 and Staff #3 came out of the facility and observed Child #1 near the sidewalk facing Avenue J. Witness #1 was holding Child #1. Staff informed Witness #1 that Child #1 attends the facility.

Witness #1 disclosed she was driving westbound down Avenue J when she observed Child #1 in the middle of the street unsupervised. Witness #1 stopped her vehicle and got out to flag vehicles that were oncoming on both directions. Witness #1 held Child #1 for approximately 20 to 30 minutes before Staff #2 and Staff #3 arrived. The incident occurred during rush hour.

Witness #1 contacted Law Enforcement who arrived shortly after. First Responders also were at the scene. First responders determined that Child #1 was fine.

LPM and LPA measured the distance from the facility gate that Child #1 exited to the location where Child #1 was found by witness #1 and the distance measures 47.6 yards.

Based on the evidence obtained, there is sufficient evidence to prove the allegation occurred; therefore, the allegation of Neglect and Lack of supervision is substantiated.

The facility was cited a Type A deficiency per Title 22 regulations. Please see LIC 9099D for details. An immediate civil penalty has been assessed as a result of Lack of Care and Supervision.

Director was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of this licensing report (LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

An exit interview was conducted and a copy of this report was provided along with the appeal rights.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 12-CC-20200918092540

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: LANCASTER UNITED METHODIST CHURCH PRE SCHOOL	FACILITY NUMBER: 191201899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/18/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/21/2020 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision: No child shall be left without the supervision, including visual observation, of a teacher at any time. This requirement is not met as evidence by on 09/17/20, Staff #1 was supervising 7 preschool children	1 2 3 4 5 6 7	Director stated that on 09/17/20 an emergency safety meeting was called. During the safety meeting a safety corrective action plan was created and completed the same date. Two alarms were installed on the emergency exit gate located on the Northwest side of the facility, a new gate latch placed inaccessible to a child, and
	8 9 10 11 12 13 14	that were playing in the courtyard. Staff #1 was giving child #1 a cup of water. Child #1 walked towards a little Tykes car to get into. Staff #1 turned around to set the pitcher of water down on the bench and by the time Staff #1 turned around, Child #1 was no longer there. Child #1 wandered out of the facility by opening the emergency exit gate facing the Northwest side of the facility leading to facility parking lot then onto a busy intersection. This is a Type A violation. This deficiency poses an immediate risk to the health and safety of children in care. $500.00 immediate civil penalty was assessed.	8 9 10 11 12 13 14	a safety doorknob was also installed. Director will conduct an overall meeting with all staff members regarding effective care and supervision, including visual supervsion at all times. Evidence of this meeting having taken place, i.e. agenda with signatures of all staff shall be provided to the Department no later than 09/21/20.
	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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3