334830693-2-17-2021-10-CC-DPAR-BYDVJ9-20210219152823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 334830693
Report Date: 02/17/2021
Date Signed: 02/17/2021 03:35:21 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2020 and conducted by Evaluator Sean R Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 10-CC-20200720103355

FACILITY NAME:	ST THOMAS EPISCOPAL PRESCHOOL		FACILITY NUMBER:	334830693
ADMINISTRATOR:	SANDRA GUAJARDO		FACILITY TYPE:	850
ADDRESS:	44651 AVENIDA DE MISSIONES		TELEPHONE:	(951) 302-8498
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92592
CAPACITY:	90	CENSUS:	DATE:	02/17/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	CHANTEL BLAS - DIRECTOR		TIME COMPLETED:	03:29 PM

ALLEGATION(S):

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Adults working in classroom without Criminal Record Clearance
Two facility classrooms have mold

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sean Williams made an unannounced phone call to ST. THOMAS EPISCOPAL PRESCHOOL for the purpose of concluding a complaint investigation via telephone regarding the above allegation(s). LPA Williams It was alleged that the facility allowed adults to work in classrooms without a criminal record clearance and two of the facility classrooms have mold in them. This report was completed via Tele-Inspections Report Delivery Instructions.

During the course of the investigation, LPA Williams conducted interviews with all relevant individuals pertinent to this investigation. It was learned during interviews, that there were two adults working at the facility for a span of approximately two months who did not have a criminal record clearance. It was also learned that there was mold found in the Firefly classroom and the Superstar classroom at the facility. Neither of the allegations were reporterd to Licensing prior to receiving this complaint. This is a violation of Title 22 regulations.

(CONTINUED ON NEXT PAGE)

Substantiated

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

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 10-CC-20200720103355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ST THOMAS EPISCOPAL PRESCHOOL	FACILITY NUMBER: 334830693
	VISIT DATE: 02/17/2021

NARRATIVE

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Although the two adults no longer work at the facility and the mold in both classrooms are now repaired, the facility still violated title 22 Regulations and the facility will be cited for two violations. (1) (101170(e)(1) Responsibility for Providing Care and Supervision (Type A) and (2) 101212 (d)(1)(C) Reporting Requirements (Type B).

Therefore, in this case, the preponderance of evidence standard has been met and both allegations are deemed SUBSTANTIATED at this time on this date.

A NOTICE OF SITE VISIT COULD NOT BE LEFT AT THE FACILITY DUE TO THE COVID-19 CRISIS. A TYPE A AND TYPE B DEFICIENCY WAS CITED DURING THIS TELE- INSPECTION. (SEE LIC809D)

A COPY OF ALL TYPE A DEFICIENCIES CITED DURING THIS INSPECTION MUST ALSO BE IMMEDIATELY (within 24 hours of the child’s next day in care) GIVEN TO THE PARENTS OF ALL CHILDREN ENROLLED IN THE CHILD CARE FACILITY AND ANY CHILDREN ENROLLED INTO THE CHILD CARE FACILITY OVER THE NEXT 12 MONTHS.

This report was completed via Tele-Inspections Report Delivery Instructions. Licensee's signatures will be obtained via email. Licensee will receive a copy of this report and appeal rights via email. This report must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC9099 (FAS) - (06/04)

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Control Number 10-CC-20200720103355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ST THOMAS EPISCOPAL PRESCHOOL	FACILITY NUMBER: 334830693
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/18/2021 Section Cited CCR 101170(e)(1)	1 2 3 4 5 6 7	Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met:	1 2 3 4 5 6 7	Both uncleared staff members are no longer working at the facility. The facility Director agrees to submita letter to CCL stating that the facility management understands that all staff members, volunteers or paid employees must have a criminal record clearance prior to working at the facility with the children. This letter will be submitted by 02/18/21.
	8 9 10 11 12 13 14	As evidenced by, the self-admission of staff members that two adults who were not criminally record cleared were working at the facility for a span approximately of two months.	8 9 10 11 12 13 14
CCR	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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 10-CC-20200720103355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: ST THOMAS EPISCOPAL PRESCHOOL	FACILITY NUMBER: 334830693
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2021 Section Cited CCR 101212(d)(1)(C)	1 2 3 4 5 6 7	(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified	1 2 3 4 5 6 7	The facility Assistant Director submitted an Unusual Incident Report to Licensing to notify of the mold found in the two classrooms after LPA Williams informed the facility Assistant Director to submit a report during the Initial Complaint investigation on 07/23/20. Mold was removed from both classrooms by a mold removal company. *********************************
	8 9 10 11 12 13 14	in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by>>>>>>>>>>>>>>>	8 9 10 11 12 13 14	********* Assistant Director provided a copy of the mold removal analysis. Director agrees to provide a letter stating that all unusual incidents will be reported to CCL per title 22 Regulations. >>> Facility staff failed to inform Community Care Licensing that mold was found in two classrooms in the facility.
	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: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Sean R Williams	TELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC9099 (FAS) - (06/04)

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