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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 304370847
Report Date: 10/07/2019
Date Signed: 10/07/2019 04:32:34 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
10/01/2019 and conducted by Evaluator Gesine Connolly
PUBLIC
COMPLAINT CONTROL NUMBER: 06-CC-20191001174337
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: 6DATE:
10/07/2019
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ashley Neitzke TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Day care children are being supervised by unqualified staff.
INVESTIGATION FINDINGS:
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An initial ten day complaint inspection was made today by Licensing Program Analyst (LPA) Connolly due to the above allegtion recieived in the licensing office 10/01/19. The director, Ashley Neitzke, accompanied the LPA to the infant room. Census was taken. There were 6 infants in care with three attending staff. All infants were awake and actively engaged in the activities of the infant room.
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.

Director, Ashley Neitzke, accompanied the LPA on a tour of the facility. Qualified staff were observed caring for the infants. Four staff were interviewed. Staff files were reviewed.
The director was informed that based upon interviews and review of files, there is not a preponderance of evidence to either support or negate the complaint allegation. It is therefore, determined to be unsubstantiated.
continued on page two


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: 10/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019
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 2
Control Number 06-CC-20191001174337
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: 10/07/2019
NARRATIVE
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page two
No deficiencies were observed.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days.

Notice of site visit was posted. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine ConnollyTELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2