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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 334844170
Report Date: 11/08/2022
Date Signed: 11/08/2022 11:20:20 AM

Substantiated


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
10/20/2022 and conducted by Evaluator Jeanette Sanchez
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20221020123142
FACILITY NAME:STORYBOOK PRESCHOOLFACILITY NUMBER:
334844170
ADMINISTRATOR:CYNTHIA ROSAFACILITY TYPE:
850
ADDRESS:31910 MISSION TRAILTELEPHONE:
(951) 387-5895
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:156CENSUS: 81DATE:
11/08/2022
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Cynthia RosaTIME COMPLETED:
11:26 AM
ALLEGATION(S):
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Staff mishandled a daycare child while in care
INVESTIGATION FINDINGS:
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On 11/8/22 at , Licensing Program Analyst (LPA) Jeanette Sanchez met with Director Cynthia Rosa to deliver final investigative findings for the allegation of personal rights violation as listed above. An initial complaint inspection was conducted on 10/25/22 and no health and safety hazards were observed. During the investigation, LPA Sanchez reviewed facility and children records. LPA Sanchez also conducted interviews.

On 10/20/22, a complaint allegation of a personal rights violation was reported to Community Care Licensing (CCL); more specifically that staff mishandled a daycare child while in care. Based on interviews, it was reported that while on the playground, Staff 1 (S1) was seen grabbing Child 1 (C1) by the arms to escort them back into the classroom. Some interviews disclosed that S1 was aggressive and C1 was crying uncontrollably. Other interviews disclosed that it appeared to be proper protocol and that
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
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 10-CC-20221020123142
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: STORYBOOK PRESCHOOL
FACILITY NUMBER: 334844170
VISIT DATE: 11/08/2022
NARRATIVE
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C1 simply didn’t want to go inside. Interviews revealed that C1 may have inadvertently swiped at S1 while physically expressing disappointment. LPA Sanchez was informed that C1 is non-verbal, therefore was unable to interview. LPA Sanchez reviewed video recording of the incident, which showed S1 immediately behind C1, with fingers wrapped around C1’s upper arms while C1’s arms were hanging horizontal to the ground (forming a “T” shape). At one point while S1 was walking C1 towards a door, C1’s legs started dragging. S1 stopped and continued walking C1 once C1 stood again, with fingers still wrapped around C1’s upper arms.

Based on record review and confidential interviews, 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 1), are being cited on the attached LIC 9099D.

An exit interview was conducted, and this report was reviewed with Director Cynthia Rosa. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 10-CC-20221020123142
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: STORYBOOK PRESCHOOL
FACILITY NUMBER: 334844170
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2022
Section Cited
CCR
101223(a)(3)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation...This requirement was not met as evidenced by:
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Director's immediate solution is to remove child from staff's classroom. Director will hold a meeting and issue memos in regards to proper protocol pertaining to addressing challenging behaviors. Director will
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A staff was seen grabbing a child forcibly, with fingers wrapped around the upper arms, which poses a potential health, safety or personal rights risk to persons in care.
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also hold a meeting with S1 regarding the findings. Director will submit copies to LPA by 11/18/2022.
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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.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5