304313142-11-18-2020-06-CC-THOO-BWAABN-20201213230457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304313142
Report Date: 11/18/2020
Date Signed: 11/18/2020 02:59:24 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
06/08/2020 and conducted by Evaluator Stacy Torrence

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20200608165856

FACILITY NAME:	DUBEY, MARIA		FACILITY NUMBER:	304313142
ADMINISTRATOR:	DUBEY, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 906-4622
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	14	CENSUS: 2	DATE:	11/18/2020
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Maria Dubey, licensee		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Facility has outbreak of lice.

INVESTIGATION FINDINGS:

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Tele-Inspection State of Emergency

Licensing Program Analyst (LPA) Stacy Torrence conducted a tele-complaint inspection, to follow-up on the tele-complaint investigation that was conducted on 06/16/2020. During the tele-investigation, LPA Torrence virtually toured the facility with Maria Dubey, licensee. Also present during today’s tele-investigation was licensee’s husband, Mark Dubey. LPA Torrence observed two children, in the daycare area.

During today’s investigation the facility was operating within its licensed capacity and within compliance of staffing ratios. A review of staff records 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.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

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 06-CC-20200608165856

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: DUBEY, MARIA	FACILITY NUMBER: 304313142
	VISIT DATE: 11/18/2020

NARRATIVE

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Allegation: facility has outbreak of lice.
Reporting Party was informed by the complainant, that the facility was infested with lice and three children got lice at the facility. During the course of the investigation, LPA interviewed licensee, complainant, five parents, and three children. Complainant disclosed noticing three children with head lice when they were picked up at the day care on June 1^st. Complainant stated licensee knew a child had lice and was not notified nor was other parents notified.
Licensee reported she noticed lice in one child’s head on May 6^th, and child return on May 11^th, with no discovering of head lice. Licensee disclosed on June 1^st, she discovered two children from one family had lice in their head, which was their last day at the day care. Licensee disclosed no other parents complained about their child having head lice. Licensee stated she did not notify licensing office of the two cases of head lice.
One out of five parents interviewed stated child had lice; however, not sure where child got the head lice. No disclosure was made from the other four parents regarding their children getting head lice at the day care. Four parents disclosed they were notified of the one child who had lice. All five parents interviewed reported no issues or concerns regarding day care.
Three children interviewed, including one of the Subject children. Subject child and child #3 stated they had head lice at the day care before.

During the course of the investigation, it was discovered that the facility had two children with head lice, at the same time, and licensee failed to report it to the licensing office. Complainant reported on June 1^st three children had head lice. Licensee reported on June 1^st two children from one family had head lice and was not reported to the licensing office.

Based on LPA interviews, the preponderance of evidence standard has been met; therefore, the Section 102416.2(c)(3) Reporting Requirement allegation is found to be substantiated. California Code of Regulations, Title 22, Division 12, and Chapter 1 is being cited on the attached LIC 9099D.

Exit interview was conducted. The report was reviewed and discussed. Appeal Rights was explained. A copy of the report along with Appeal Rights (LIC 9058 12/15) will be emailed to licensee with a Read Receipt to acknowledge report was received. If Read Receipt is not functional, licensee will respond to email stating “I have read and received the report, I acknowledge receipt.” LIC 9099 will also be mailed if those options are not available. The Notice of Site Visit was not posted due to tele-investigation COVID-19 State of Emergency.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20200608165856

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: DUBEY, MARIA	FACILITY NUMBER: 304313142
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/18/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/24/2020 Section Cited CCR 102416.2(c)(3)	1 2 3 4 5 6 7	102416.2(c)(3) Reporting Requirement.(c)In addition to the events specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C), the licensee shall report the following events to the Department: (3) A communicable disease outbreak when determined by the local health authority.	1 2 3 4 5 6 7	Per Licensee, she will submit a written statement indicating that she will report to licensing office of any future occurrence of outbreaks at the facility. Written statement is due to LPA by POC due date of 11/24/2020.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: interview with the licensee, licensee disclosed on June 1st, two children from one family had lice, and this was not reported to licensing. This poses a potential health risk to the 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: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020

LIC9099 (FAS) - (06/04)

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