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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197414519
Report Date: 09/23/2019
Date Signed: 11/25/2019 04:54:50 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
09/17/2019 and conducted by Evaluator Laura Villanueva
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20190917134612
FACILITY NAME:NEW YERBA BUENA ELEMENTARY SITE, THEFACILITY NUMBER:
197414519
ADMINISTRATOR:BILLIEJO ROMPALFACILITY TYPE:
840
ADDRESS:6098 REYES ADOBE RD.TELEPHONE:
(818) 735-0112
CITY:AGOURA HILLSSTATE: CAZIP CODE:
91301
CAPACITY:40CENSUS: 31DATE:
09/23/2019
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ash GalardiTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Facility is operating out of ratio.
Children are not being properly supervised while in care.
INVESTIGATION FINDINGS:
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 THIS REPORT IS AN AMENDMENT TO THE REPORT ISSUED ON 9/23/19.

Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to the after school program to conduct an initial investigation of the above allegations.

LPA met with the Director, Ash Galardi and explained the purpose of the visit then toured the center. There were a total of 22 children when LPA arrived with 3 staff. 9 children arrived later. Staff were going from one room to the other gathering supplies for the children to work with. At one point from 2:55 PM to 3:05 PM LPA was alone in a room with 22 children. There were no staff supervising the children.

Based on LPA's observations, the preponderance of evidence standard been met, therefore the above allegations has been found to be SUBSTANTIATED. California Code of Reghasulations, Title 22 Division 12, 101218.1(b)(4) is being cited on the attached LIC 9099 D.

Appeal Rights explained and provided to Director. A Notice of Site visit was provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
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 2
Control Number 17-CC-20190917134612
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: NEW YERBA BUENA ELEMENTARY SITE, THE
FACILITY NUMBER: 197414519
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
HSC
101516.5(b)(1)
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(b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance (1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children.

This requirement was not met as evidenced by:
Teachers went back and fourth between rooms leaving at times no teacher in the room in LPA's presence.
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Center will submit written plan or correction by 9/30/19 on how they will be addressing the staffing situation.
Center will be brought into the Santa Barbara Regional Office for an Informal conference regarding LPA's observations.
Type A
09/23/2019
Section Cited
HSC
101229(a)(1)
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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by:
Teachers moving around from room to room leaving the children completely unattended at times as observed by LPA.
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Center will submit written plan or correction by 9/30/19 on how they will be addressing the lavk of supervision.
Center will be brought into the Santa Barbara Regional Office for an Informal conference regarding LPA's observations.
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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: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
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 2