191225916-9-23-2019-17-CC-GMIE-BGL27M-20191002170859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191225916
Report Date: 09/23/2019
Date Signed: 09/23/2019 04:35:22 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2019 and conducted by Evaluator Michael Avila

PUBLIC

COMPLAINT CONTROL NUMBER: 17-CC-20190919113659

FACILITY NAME:	WILLOW KIDS WORLD		FACILITY NUMBER:	191225916
ADMINISTRATOR:	SHUNTA HUTCHINS		FACILITY TYPE:	840
ADDRESS:	29026 LARO DR.		TELEPHONE:	(818) 879-9665
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY:	90	CENSUS: 62	DATE:	09/23/2019
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Megan Tisler		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Facility is operating beyond the scope of its license.

INVESTIGATION FINDINGS:

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Allegation deemed SUBSTANTIATED. Investigation includes LPA observations and staff interviews.

Licensing Program Analyst (LPA) Michael Avila made an unannounced visit for the purpose of initiating a complaint investigation into the above allegation. LPA Avila met with site director Megan Tisler and discussed the nature and purpose of the visit. Upon arrival at the facility, LPA Avila observed 62 children being supervised by 4 staff members. LPA asked the Director how many children were in care, the Director advised there were 21 children in care in one classroom and 41 children in care in the next adjacent classroom.

Based on LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number 1), are being cited on the attached LIC 9099D.

Report continued on attached 9099C.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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 17-CC-20190919113659

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: WILLOW KIDS WORLD	FACILITY NUMBER: 191225916
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/23/2019 Section Cited CCR 101516.5(a)(1)	1 2 3 4 5 6 7	Teacher Child Ratio states a teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement was not met as evident by LPA observation during an unannounced visit, there were 62 children in care with 4 staff members. which poses an immediate health and safety risk to clients/children in care.	1 2 3 4 5 6 7	Licensee shall appear at the Santa Barbara Regional Office at a date and time later to be determined by the Department for an Informal Conference to discuss this deficiency citation.
	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
	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: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 17-CC-20190919113659

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: WILLOW KIDS WORLD	FACILITY NUMBER: 191225916
	VISIT DATE: 09/23/2019

NARRATIVE

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Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 9099 and LIC 9099 D.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

LPA's observed Director post notice of site visit.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael Avila	TELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC9099 (FAS) - (06/04)

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