304370847-7-8-2019-06-CC-JHAN-BDY23J-20190710170226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304370847
Report Date: 07/08/2019
Date Signed: 07/08/2019 02:58:40 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
04/29/2019 and conducted by Evaluator Gesine Connolly

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20190429135716

FACILITY NAME:	NOBIS PRESCHOOL		FACILITY NUMBER:	304370847
ADMINISTRATOR:	NEITZKE, ASHLEY		FACILITY TYPE:	830
ADDRESS:	26153 VICTORIA BLVD.		TELEPHONE:	(949) 661-6258
CITY:	CAPISTRANO BEACH	STATE: CA	ZIP CODE:	92624
CAPACITY:	16	CENSUS: 4	DATE:	07/08/2019
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Ashley Neitzke		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility has a fire hazard.

INVESTIGATION FINDINGS:

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A subsequent complaint inspection was conducted on this date by Licensing Program Analyst (LPA) Connolly. Upon arrival LPA met with director, Ashley Neitzke, who accompanied the LPA on a tour of the infant program. Census was taken as follow: 4 infants with two staff. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances.

During the initial complaint inspection on 5/01/19 four staff interviews were conducted as well as a tour of the infant center. Based on this initial LPA complaint visit a request for an additional fire authority inspection was made by the Department. On 5/23/19 the fire authority made the inspection. The need for corrections involving the placement of electrical cords was noted. A follow up fire authority inspection was made 6/28/19 verifying corrections. These corrections were again verified by the LPA's tour of the facility today.
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

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 3

Control Number 06-CC-20190429135716

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: NOBIS PRESCHOOL	FACILITY NUMBER: 304370847
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/08/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/08/2019 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	101238(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This regulation was not met as evidenced by the fire authority determining the replacement of electrical cord outlets. The presence of multiple cords in one power surge	1 2 3 4 5 6 7	Per fire authority the corrections noted by the fire authority have been completed. Panels of electrical outlets have been installed by the facility. These installations observed today by the LPA have been approved by the fire authority.
	8 9 10 11 12 13 14	posed a potential risk.	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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 06-CC-20190429135716

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: NOBIS PRESCHOOL	FACILITY NUMBER: 304370847
	VISIT DATE: 07/08/2019

NARRATIVE

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The director was informed today that based on the above information, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division & Chapter 1, Buildings and Grounds 101238 (a) is being cited on the attached LIC 9099D.

Exit interview was conducted. The Notice of Site Visit was posted. The director was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. “The licensee was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.”

This citation, 101238 A is cleared today as corrections specified by the fire authority have been made and verified by the issuance of a current fire clearance. Fire authority violation is noted cleared.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gesine Connolly	TELEPHONE: (714) 703-2822
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2019

LIC9099 (FAS) - (06/04)

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