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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370847
Report Date: 10/22/2019
Date Signed: 10/25/2019 08:36:56 AM



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
07/18/2019 and conducted by Evaluator Gesine Connolly
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20190718103559
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: 0DATE:
10/22/2019
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ashley Neitzke TIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
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7
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9
Day care child sustained unexplained injuries while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
During today's regional office meeting Licensing Program Analyst (LPA) Connolly met with director Ashley Nietzke to give the findings of an investigation conducted by an Investigations Branch (IB) investigator, Andrew Murrow. This IB investigation was initiated when an allegation a child care child sustained unexplained injuries while in care was received in the licensing office 7/18/19.
During today's office meeting the above allegation was discussed with the director. The director was informed the IB investigator, during the course of the investigation, interviewed four staff as well as reviewing medical records. In addition the IB investigator conducted a physician interview. Three adult interviews were also conducted. These adults had involvement with the infant care program of Nobis Preschool.
The director was informed that based on the IB investigator's interviews and record reviews,there is not a preponderance of evidence to either support or negate the complaint allegation that an infant while in care sustained unexplained injuries. The allegation, therefore, is determined to be unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine ConnollyTELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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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