<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418346
Report Date: 12/28/2021
Date Signed: 12/28/2021 11:56:27 AM



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
10/15/2021 and conducted by Evaluator Liana Stepanyan
COMPLAINT CONTROL NUMBER: 12-CC-20211015111156
FACILITY NAME:BETHLEHEM LUTHERAN SCHOOLFACILITY NUMBER:
197418346
ADMINISTRATOR:FERRARA, TONIFACILITY TYPE:
850
ADDRESS:27265 LUTHER DRIVETELEPHONE:
(661) 251-6027
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:98CENSUS: 0DATE:
12/28/2021
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Toni Ferrara, LicenseeTIME COMPLETED:
12:08 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights-Facility staff do not encourage the children to wear a mask

Record Keeping-Facility staff do not require day-care children to be sign in/out by their parents/guardians
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Liana Stepanyan and Mariela Ramon Licensing Program Manager (LPM) conducted a subsequent complaint investigation inspection for the purpose to deliver the findings of the above allegations. Upon arrival, LPA and LPM met with licensee. LPA and LPM observed 0 children and 2 staff members who were wearing facial coverings. Licensee disclosed preschool is closed for this week and will re-open January 3rd 2022. The investigation of the above allegation consisted of children, staff interviews, record reviews, and LPAs observations.

On 10/20/21, during a complaint investigation inspection, LPAs observed 2 staff members wearing facial coverings and 18 children not wearing facial covering inside the facility. During interviews conducted with child #1, child #2, and child #3, children disclosed they do not wear facial coverings while in care during indoor activities. During today’s inspection, licensee disclosed children over the age of 2 now wear facial covering while indoors. See investigation report 9099C for additional information.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
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-20211015111156
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: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197418346
VISIT DATE: 12/28/2021
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
LPAs Stepanyan and King-Lewis collected children sign in/out sheets for review. The review revealed parents are not consistently signing in and signing out their children. The licensee and facility staff disclosed that they were using a program application with QR code for sign in and sign out for the children. Per licensee, parents reported the application malfunctioned and was not recording their child was checked in. Licensee decided to covert to the old way which consist of parents signing the Daily Sign In/Out Sheet located in front of the classroom.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the allegations of children not wearing facial coverings and parents not sign in/out their children is found to be substantiated. California Code of Regulations, (Title 22, Division 12 & Chapter 1).

The facility was cited Type B violations. See complaint investigation report LIC 9099D for deficiencies cited.

An exit interview was conducted, a copy of this report, notice of site visit and appeal rights were provided to the licensee.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20211015111156
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: BETHLEHEM LUTHERAN SCHOOL
FACILITY NUMBER: 197418346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/11/2022
Section Cited
CCR
101223(a)(2)
1
2
3
4
5
6
7
Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs. This requirement was not met as evidence by on 10/20/21, LPAs observed that 18 children
1
2
3
4
5
6
7
Licensee disclosed that effective 10/21/21 children over the age of 2 are wearing facial coverings while indoors. Licensee also stated she has additional mask available to ensure all children wear facial coverings. Licensee will submit to the department a declaration indicating the aforementioned statement no later than 01/11/22
8
9
10
11
12
13
14
were not wearing facial coverings while indoors. During interviews conducted children disclosed they do not wear facial coverings. This is a type B deficiency which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
Type B
01/11/2022
Section Cited
CCR
101229.1(a)(1)
1
2
3
4
5
6
7
Sign In and Sign Out: In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: This requirement was not met as evidence by parents are not
1
2
3
4
5
6
7
Per licensee, when accepting a child a staff member will ensure their parent/guardian sign the child in on the sign in/out sheet. Staff member will also ensure parents sign out the child before releasing the child.
8
9
10
11
12
13
14
consistently signing in and signing out their children. This is a type B deficiency which poses a potential Health, Safety or Personal Rights risk to children in care.
8
9
10
11
12
13
14
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3