191600429-7-29-2021-30-CC-MNEL-C5LMD7-20210805093038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191600429
Report Date: 07/29/2021
Date Signed: 07/29/2021 02:46:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2021 and conducted by Evaluator Sabrina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210510135455

FACILITY NAME:	MALIBU METHODIST CHURCH NURSERY SCHOOL		FACILITY NUMBER:	191600429
ADMINISTRATOR:	KIRSTEN BOWMAN		FACILITY TYPE:	850
ADDRESS:	30128 MORNING VIEW DRIVE		TELEPHONE:	(310) 457-5144
CITY:	MALIBU	STATE: CA	ZIP CODE:	90265
CAPACITY:	42	CENSUS: 25	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Kirsten Bowman, Center Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Allegation #1: Staff denied authorized representative access to a daycare child.

INVESTIGATION FINDINGS:

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

On 07/29/2021 at 11:50 am, Licensing Program Analyst (LPA) Sabrina Martinez arrived at Malibu Methodist Church Nursery School for the purpose of delivering the complaint investigation findings.

Upon arrival, LPA Martinez met with Kirsten Bowman, Center Director. LPA Martinez followed COVID-19 Safety Guidelines during this investigation, LPA wore a face covering, sanitized hands, and maintained social distance whenever possible. There were 25 children and 5 teachers present during this inspection. The investigation consisted of interviews with all pertinent complaint parties and review of records such as children’s records and facility sign in/sign out sheet. The investigation revealed that on 01/07/2021, Child #1 was signed out from the facility at 1:23 pm and the incident occurred while the child was already in the care of grandma. The facility immediately notified parent #1 regarding the incident. Based on the evidence obtained during the investigation, there is no preponderance of evidence to prove or disprove that the allegation is found to be true, therefore the finding is Unsubstantiated. An exit interview was conducted with licensee, a copy of this report was provided along with the appeal rights.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2021 and conducted by Evaluator Sabrina Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 30-CC-20210510135455

FACILITY NAME:	MALIBU METHODIST CHURCH NURSERY SCHOOL		FACILITY NUMBER:	191600429
ADMINISTRATOR:	KIRSTEN BOWMAN		FACILITY TYPE:	850
ADDRESS:	30128 MORNING VIEW DRIVE		TELEPHONE:	(310) 457-5144
CITY:	MALIBU	STATE: CA	ZIP CODE:	90265
CAPACITY:	42	CENSUS: 25	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Kirsten Bowman, Center Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Allegation #2: Staff did not provide a copy of admission agreement to authorized representative.

INVESTIGATION FINDINGS:

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

On 07/29/2021 at 11:50 am, Licensing Program Analyst (LPA) Sabrina Martinez arrived at Malibu Methodist Church Nursery School for the purpose of delivering the complaint investigation findings.
Upon arrival, LPA Martinez met with Kirsten Bowman, Center Director. LPA Martinez followed COVID-19 Safety Guidelines during this investigation, LPA wore a face covering, sanitized hands, and maintained social distance whenever possible. There were 25 children and 5 teachers present during this inspection. The investigation consisted of interviews with all pertinent complaint parties and review of records such as children’s records and facility sign in/sign out sheet. The investigation revealed that facility failed to respond to parent’s request of obtaining a copy of the facility’s handbook/school policy.
Based on the evidence obtained during the investigation, the allegation that staff did not provide a copy of admission agreement to authorized representative is substantiated. Substantiated-an allegation that is considered valid because the preponderance of the evidence standard has been met.The facility is cited a Type B citation today, 07/29/2021. (See LIC 9099-D for deficiency page). An exit interview was conducted with licensee, a copy of this report was provided along with the appeal rights.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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

Control Number 30-CC-20210510135455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MALIBU METHODIST CHURCH NURSERY SCHOOL	FACILITY NUMBER: 191600429
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/06/2021 Section Cited CCR 101218.1(a)(B)	1 2 3 4 5 6 7	Admission Procedures and Parental and Authorized Representative's Rights. Provides the child's parent...with information about the child care center that shall at least include the child care center's admission policies and procedures...This requirement is not met as evidenced by: Facility failed	1 2 3 4 5 6 7	Facility will provide the Department with a written declaration on how the facility will ensure that the school handbook/policy will be immediately available to parents upon their request. Director will email LPA with a copy of the declaration/written statement. POC due by August 06, 2021.
	8 9 10 11 12 13 14	to respond or provide parent a copy of the school's policy/hand book. This is a Type B citation and 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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sabrina Martinez	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC9099 (FAS) - (06/04)

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