304371179-2-14-2022-06-CC-PMAA-CBW9HA-20220222222250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371179
Report Date: 02/11/2022
Date Signed: 02/14/2022 02:24:54 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
12/14/2021 and conducted by Evaluator Stacy Torrence

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20211214170110

FACILITY NAME:	CALVARY CHAPEL OF YORBA LINDA		FACILITY NUMBER:	304371179
ADMINISTRATOR:	MYERS, BRENDA		FACILITY TYPE:	850
ADDRESS:	18821 YORBA LINDA BLVD.		TELEPHONE:	(714) 777-7131
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	115	CENSUS: 67	DATE:	02/11/2022
		UNANNOUNCED	TIME BEGAN:	01:06 PM
MET WITH:	Brenda Myers, Director		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff not wearing mask.

INVESTIGATION FINDINGS:

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On 02/11/2022, Licensing Program Analyst (LPA) Stacy Torrence conducted an in-person inspection to deliver the findings regarding the above complaint allegation. LPA Torrence met with Director Brenda Myers. The COVID-19 Emergency Response questionnaire were asked. There was a total of 67 napping preschool children present, with 11 staff supervising. A review of staff criminal clearance 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.

On 12/14/2021, Licensing office received a complaint alleging the following: staff not wearing mask.

During the course of the investigation, LPA Torrence conducted a phone interview with complainant. Complainant stated it was observed staff not wearing mask inside the classroom.

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: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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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Control Number 06-CC-20211214170110

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: CALVARY CHAPEL OF YORBA LINDA	FACILITY NUMBER: 304371179
	VISIT DATE: 02/11/2022

NARRATIVE

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During the course of the investigation, on 12/16/2021, during an inspection of the facility, LPA Torrence entered classroom 102 and classroom 103 and observed two staff not wearing face covering. LPA Torrence asked Staff 2(S2) why she was not wearing a face covering and she replied by saying it’s on my person and shrugged her shoulders, then properly placed the face mask on her face. Upon LPA Torrence entering Staff 3(S3) classroom, she observed S3 immediately placing her face mask over her nose and mouth.

During the course of the investigation, LPA interviewed Staff 1 (S1). S1 stated they try and check staff to ensure they are wearing their face covering. S1 also stated that every staff member knows to wear their mask, while inside the classroom.

During the course of the investigation, LPA Torrence contacted 10 parents and interviewed four. Parent 3 (P3) indicated it’s been most recent that the teachers and staff started wearing mask other than that P3 had no other issues or concerns with the facility. Interviewed parents had no issues or concerns with the facility.

Based on LPA observations and interviews conducted the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 3, 101223(a)(2) Personal Rights are being cited on the attached LIC9099D.

Exit interview was conducted. The Notice of Site Visit was posted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

End of Report

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 06-CC-20211214170110

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: CALVARY CHAPEL OF YORBA LINDA	FACILITY NUMBER: 304371179
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/18/2022 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223(a)(2) Personal Rights. The licensee shall ensure that each child is accorded the following..To be accorded safe,healthful...This requirement is not met as evidenced by: On 12/16/2021, facility rep. failed to ensure the personal rights of children in care to safe and healthful accommodations,in that facility's S2	1 2 3 4 5 6 7	Per Director, she will send out a reminder memo email to all staff to ensure, they understand the importance of wearing face covering indoor and how it's a violation of the child's personal rights. Per Director, she will have each staff sign the memo indicating they acknowledge and understand it. Director stated she will email LPA the memo with each staff signature by POC due date of 02/18/2022.
	8 9 10 11 12 13 14	and S3 did not wear face covering indoors as required by the State Public Health Officer order dated June 11, 2021, requiring compliance with CDPH Guidance for the Use of Face Covering, and the Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS) An exemption to the Order requiring face coverings did not apply. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
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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: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Stacy Torrence	TELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

LIC9099 (FAS) - (06/04)

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