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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300600390
Report Date: 12/21/2021
Date Signed: 12/21/2021 01:22:24 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/08/2021 and conducted by Evaluator Pat Rivas
COMPLAINT CONTROL NUMBER: 06-CC-20211008163302
FACILITY NAME:GOOD SHEPHERD PRE SCHOOLFACILITY NUMBER:
300600390
ADMINISTRATOR:ALVAREZ-MACKOW, BERNADETTEFACILITY TYPE:
850
ADDRESS:7082 CRESCENT AVENUETELEPHONE:
(714) 827-6440
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:74CENSUS: 17DATE:
12/21/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kristy Farmer, Lead TeacherTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility staff pulled child's ear
INVESTIGATION FINDINGS:
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LIcensing Program Analyst (LPA) P Rivas conducted an unannounced complaint visit in order to investiage the above allegations. Upon arrival LPA met with Staff Kristy Farmer.

There were 2 teachers in classroom#1 with 7 children, 1 teacher in classroom#3 with 5 children; in classroom#4 there was 1 teacher with 5 children. Based upon LPA’s observation Licensee is operating within the licensed capacity as specified on license.
A review of the Facility Personnel Report Summary and staff files on this date 10/12/2021 at 09:00 AM indicated all facility staff present or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The investigation consisted of Staff file reviews; Five of Five files was reviewed. Five staff interviews (including Director); Interview with Five of Five Parents. Interview with 7 of 12 children. Three children were not interviewed, one had only attended program for a few days, two did not speak.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
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 4
Control Number 06-CC-20211008163302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GOOD SHEPHERD PRE SCHOOL
FACILITY NUMBER: 300600390
VISIT DATE: 12/21/2021
NARRATIVE
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In reference to the allegation that staff pulled a child's ear. It was alleged that an incident occurred on
10/06/21 in which one staff pulled a child's ear. LPA interviewed four staff and director from approximately 10:30am to 1:00pm. Director reported not being present on date of incident. However, staff reported alleged
incident to Director. Director stated that she had not submitted an incident report to CCL because she was not sure it happened. Three staff were present in Room #1. One staff interviewed alleged seeing staff pull child's ear. Staff#3(S3) reported Child#1(C1) on date of incident cried to S3 saying S1 had pulled C1’s ear.
One other staff denied seeing staff pull child's ear. Last staff denied pulling child's ear. LPA interviewed Seven of Twelve Children from 9:00am to 11:00am. LPA was unable to qualify two children. A third child had only been in the program for a few days. The fourth and fifth child could not communicate with LPA. Four of the twelve children indicated they did not know of anyone's ear being pulled. Three of the twelve children indicated either having their ear pulled by staff or seeing staff pull another child's ear, including alleged victim of incident 10/06/21. Five of Five parents were interviewed from 1:00 to 2:00pm and all indicated there were no issues or concerns with facility. Three of the five parents interviewed were parents to children that had indicated having their ear pulled or seeing another child's ear pulled.

Based on LPAs observations and interviews which were conducted 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 12 and Chapter 1 are being cited on the attached LIC 9099D.

The Notice of Site Visit was given and discussed it must be posted as required by H & S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00.

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 06-CC-20211008163302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GOOD SHEPHERD PRE SCHOOL
FACILITY NUMBER: 300600390
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/22/2021
Section Cited
CCR
101223(a)3
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Personal RightsThe licensee shall ensure that each child is accorded the following personal rights:To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning
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Staff1 will be trained in personal rights under Title 22 and Director /designee will provide copy of traing to LPA by plan of correction date
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This requirement was not met as evidenced by interviews with staff, children. Four individuals reported to either seeing staff #1 pull a child’s ear, having their ears pulled or having a child disclose to them that staff#1 pulled their ear. This poses an immediate health and safety issue for children in care.

Staff1 will be trained in personal rights and Director will provide copy of traing to LPA by plan of correction dat
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Type B
12/28/2021
Section Cited
CCR
101212(d)(1)D
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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Dept by telephone or fax within the Dept next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Dept within seven days following the occurrence of such event
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Director will complete an unusual incident report and submit to LPA Rivas by plan of correction date
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Events reported shall include the following: Any suspected physical or psychological abuse of any child.
This requirement was not met as evidenced by interview with Director, who stated she was advised by staff of alleged incident but she did not file an unusual incident report because she didn’t think staff was sure of what was seen. This poses a potential risk to children in care.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 06-CC-20211008163302
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GOOD SHEPHERD PRE SCHOOL
FACILITY NUMBER: 300600390
VISIT DATE: 12/21/2021
NARRATIVE
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LPA P Rivas informed facility representative, Kristy Farmer that this report dated 12/21/21 document(s) (1 Type A citation) Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA PRivas informed the facility representative, Ms. Farmer to provide a copy of this licensing report dated 12/21/21 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with director. Appeal Rights were explained. The Director was provided a copy of appeal rights (LIC 9058) 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the Regional Manager to the address listed.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4