300604107-4-16-2021-06-CC-PMAA-C25VL5-20210416163123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300604107
Report Date: 04/16/2021
Date Signed: 04/16/2021 04:18:29 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
12/04/2020 and conducted by Evaluator Jordann Nelson

COMPLAINT CONTROL NUMBER: 06-CC-20201204121456

FACILITY NAME:	MONARCH PRESCHOOL		FACILITY NUMBER:	300604107
ADMINISTRATOR:	VANESSA COLLETT		FACILITY TYPE:	850
ADDRESS:	5702 CLARK DRIVE		TELEPHONE:	(714) 846-2713
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92649
CAPACITY:	32	CENSUS: 16	DATE:	04/16/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Vanessa Collett-Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility does not have record of immunization for children in care.

INVESTIGATION FINDINGS:

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Tele-Inspection-COVID 19 State of Emergency

On 04/16/2021 Licensing Program Analyst (LPA) Jordann Nelson conducted an announced complaint Tele-Inspection regarding the allegation listed above with Director Vanessa Collet. The director was informed that due to COVID-19 and social distancing guidelines, the visit would be conducted via Facetime.

A review of staff personnel roster (LIC 500) on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions. There were 16 children in care with 5 attending staff.

continued on page 2.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann Nelson	TELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

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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Control Number 06-CC-20201204121456

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: MONARCH PRESCHOOL	FACILITY NUMBER: 300604107
	VISIT DATE: 04/16/2021

NARRATIVE

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continued from page 2
The department received a complaint that the facility does not have immunization record for a child in care, LPA Nelson conducted interviews with four staff, the director and two parents. LPA Nelson also requested and reviewed the immunization files. On 12/08/2020 LPA Nelson requested the immunization record to be provided to Licensing by close of business. When LPA Nelson called the following day, LPA Nelson was told that the document was still coming rather no time frame was provided. On 12/14 /2020 the immunization record was provided via email.

During a follow up visit on 03/03/2021 the center director stated that the almost week delay in providing the immunization records was based on the facility not having the immunization record on hand. Interview was conducted with the parent , the parent stated that the delay to provide the immunization record to the school was due to the physician not able to provide the immunization record timely manner. Based on the immunization records not being provided or in the the file the above allegation is substantiated.

Based on California Code of Regulations, Title 22, Division 12 Chapter 1 101221 Child Records. The child immunization record was not in place upon immediate request. Please refer to LIC 809-D. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

Exit interview was conducted with director Vanessa Collett via Tele-Inspection. Report was read to director. A copy of the report along with Appeal Rights will be emailed to Licensee with a Read Receipt to acknowledge report was received. Director was asked to respond to email by copying the following, “I have read and received the Investigation Report and Appeal Rights, I acknowledge receipt.” All appeals must be in writing and received by the Licensing office within 15 business days.

End of report.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann Nelson	TELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20201204121456

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: MONARCH PRESCHOOL	FACILITY NUMBER: 300604107
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/16/2021 Section Cited HSC 101221(a)	1 2 3 4 5 6 7	Child's Records a separate, complete and current record for each child is maintained in the childcare center. Immunization records as specified….This was not met as evidence by:	1 2 3 4 5 6 7	The director will audit all child files. Ensuring that the files have the required licensing forms on record.The director will submit an audit plan to CCL to ensure all files meet CCL forms and regualtion requirments by May 15, 2021
	8 9 10 11 12 13 14	Based on record review on 12/08/2020 Licensing Analyst requested the immunization record for a child in care be provided. The record was not provided until 12/14/2021. Lack of not providing the record upon request the facility was in violation of not having the required licensing forms.	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: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jordann Nelson	TELEPHONE: (714) 743-8228
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

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