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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370847
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:52:12 PM

Substantiated


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
10/19/2022 and conducted by Evaluator Pat Rivas
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20221019171748
FACILITY NAME:NOBIS PRESCHOOLFACILITY NUMBER:
304370847
ADMINISTRATOR:NEITZKE, ASHLEYFACILITY TYPE:
830
ADDRESS:26153 VICTORIA BLVD.TELEPHONE:
(949) 661-6258
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:16CENSUS: 13DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ashley Neitzke, DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility floors/carpets are not kept clean.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Rivas conducted an unannounced visit to render findings for the above allegation.
LPA Rivas met with facility manager Erica Benavides director Ashley Nietzke and was taken on a tour of the facility. There were 6 infants sleeping with 1 staff; 7 infants awake with 2 staff, as visit progressed two more staff arrived..

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

On 10/19/22 The Regional Office Received a complaint with the allegation that floors/carpets are not kept clean.

(continued on page 2)
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: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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 5
Control Number 06-CC-20221019171748
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: 10/26/2022
NARRATIVE
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The investigation consisted of physical plant tour on 10/21/22 and 10/26/22, interview with 6 staff and facility manager and director. Review of facility files including third party cleaning contract.

The following was found; Interviews with 6 staff indicated they are unaware of when cleaning company comes. Three of six believe company only comes on weekends based on observations of crumbs left from the day prior's snacks. Interview with manager indicates she did notify director and owner about stains. Third party contractor came to facility on 10/23 and 10/24 LPA's observation on 10/21/22 noted dark spots/stains on carpet floor and dark spot underneath mat which covered the spot on the floor. LPAs observation on 10/26/22 noted dark spot on carpet floor still slightly visible but not as pronounced. Review of records show that in April 2022 third party cleaned carpeting. Review of third party work schedule did not include sweeping but it did include detail vacuum 5 days a week, vacuuming of area rugs and areas underneath 5 days a week. Per Director, contract has been on going since licensure.

Based on interview statements and observation, the allegation referenced on this report is substantiated. A substantiated finding means that the complaint is substantiated, and the allegation is valid because the preponderance of the evidence standard has been met. The following violation was revealed and is being cited a Type B in accordance with California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101238.3(b) please refer to attached 9099 (D).

Exit interview conducted and report was reviewed with the Ashley Neitzke, Director. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) 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.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 06-CC-20221019171748
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: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2022
Section Cited
CCR
101238.3(b)
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Indoor Activity Space
The floors of all rooms shall have a surface that is safe and clean.This requirement was not met as evidenced by LPAs observation, and staff interviews. This poses a potential hazard to children in care
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Licensee will repair and or replace carpeting and obtain area rugs/mats which can be alternated on a daily basis for spot cleaning . Copy of receipts and pictures to be sent to LPA Rivas by plan of correction date.
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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: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/19/2022 and conducted by Evaluator Pat Rivas
COMPLAINT CONTROL NUMBER: 06-CC-20221019171748

FACILITY NAME:NOBIS PRESCHOOLFACILITY NUMBER:
304370847
ADMINISTRATOR:NEITZKE, ASHLEYFACILITY TYPE:
830
ADDRESS:26153 VICTORIA BLVD.TELEPHONE:
(949) 661-6258
CITY:CAPISTRANO BEACHSTATE: CAZIP CODE:
92624
CAPACITY:16CENSUS: 13DATE:
10/26/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Ashley Neitzke, DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility has mold.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Rivas conducted an unannounced visit to render findings for the above allegation.
LPA Rivas met with facility manager Erica Benavides director Ashley Nietzke and was taken on a tour of the facility. There were 6 infants sleeping with 1 staff; 7 infants awake with 2 staff, as visit progressed two more staff arrived..

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

On 10/19/22 The Regional Office Received a complaint with the allegation that facility has mold.
(cont on page 2)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 06-CC-20221019171748
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: 10/26/2022
NARRATIVE
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Page 2

The investigation consisted of staff interviews, LPA's observations, third party contractor information.

The investigation found: Interviews with 5 out of 6 staff indicated they had observed black spot on rug and a black spot underneath mat which had been placed over black spot on rug. Interviews further indicated there had not been any black spots on mat prior to being placed on carpeting. Interview with Manager, Erica Benavides indicated she had been made aware of black spot on mat and on floor on 10/19/22 and the owner had scheduled cleaning over the weekend on 10/22/22 and 10/23/22. LPA observed black spot on infant rug and underneath mat which was placed over black spot on rug. LPA obtained documentation from third party cleaning company which they report no mold .

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Ashley Neitzke, Drector. 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.

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: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5