364813742-12-6-2021-12-CC-SHEG-CA5PHX-20211228102042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364813742
Report Date: 12/06/2021
Date Signed: 12/06/2021 07:10:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/03/2021 and conducted by Evaluator Kendal Zirbes

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20211203160029

FACILITY NAME:	ANDERSON COUNTRY PRESCHOOL		FACILITY NUMBER:	364813742
ADMINISTRATOR:	BEVERLY ANDERSON		FACILITY TYPE:	850
ADDRESS:	1023 PARADISE WAY		TELEPHONE:	(909) 505-7112
CITY:	BIG BEAR CITY	STATE: CA	ZIP CODE:	92314
CAPACITY:	45	CENSUS: 17	DATE:	12/06/2021
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Assistant Director Katie Anderson		TIME COMPLETED:	07:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not follow State COVID-19 mandated guidelines
Child files were missing from the child care center.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Zirbes met with Teacher Ximena Porter and Assistant Director Katie Anderson. The purpose of the inspection was to initiate a complaint investigation at the licensed facility regarding the above allegations. LPA disclosed the purpose of the inspection to the Teacher and Assistant Director. Present during today’s inspection were 17 childcare children, three staff members and the Assistant Director.
During the inspection the following was observed: 15 preschool age children, and three staff members were within the gym area of the facility. The Assistant Director, one preschool age child and one kindergarten age child were in the pre-k classroom. LPA observed that the staff, assistant director nor any of the children over two years of age were wearing facial coverings as defined by Public Health. Assistant Director stated facial covering have not been worn inside the facility since the beginning of 2021. Assistant Director stated the facility is keeping the facility clean by completing daily symptoms checks with the children, consistent hand washing and continued disinfecting throughout the day. Report continued on page two

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

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 3

Control Number 12-CC-20211203160029

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ANDERSON COUNTRY PRESCHOOL	FACILITY NUMBER: 364813742
	VISIT DATE: 12/06/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Furthermore, during this inspection, LPA addressed the facility failing to have four child files during an inspection in November 2021 Assistant Director confirmed the child files were not present during the November 2021 inspection.
Based on the information obtained, interviews conducted and LPA’s own observations, there is a preponderance of evidence to prove the staff did not follow State COVID-19 mandated guidelines and child files were missing from the childcare center in November 2021. Therefore, the above allegations are substantiated, and deficiencies were cited. During the inspection Assistant Director was advised a Non-Compliance Conference (NCC) will be held on December 16, 2021 at 1:30pm at the Palmdale Regional office. An email will be provided to the Licensee and Assistant Director regarding the NCC meeting. An exit interview was conducted, a copy of this report, and notice of site visit were provided to Assistant Director.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 12-CC-20211203160029

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ANDERSON COUNTRY PRESCHOOL	FACILITY NUMBER: 364813742
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/06/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/07/2021 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223 (a)(2) Personal Rights: To be accorded safe, healthful and comfortable accommodations, .. and equipment to meet his/her needs. This requirement was not met as evidenced by: LPA observed neither children nor staff were wearing facial coverings in accordance to CA public heath and safety guidelines.	1 2 3 4 5 6 7	Per Assistant Director staff wear masks and children will be encouraged to wear masks. Assistant Director will reach out to CCRC for assistance in supplies.
	8 9 10 11 12 13 14	This is a potential health, safety or personal rights risk in that all children and adults over the age of 2 are required to wear facial coverings in indoor settings to help mitigate the spread and transmission of Covid -19 and in accordance to CA Public Health and Safety Guidelines.	8 9 10 11 12 13 14
Type B 12/06/2021 Section Cited CCR 101221(a)	1 2 3 4 5 6 7	101221 (a) Child's Records: A separate, complete, and current record for each child is maintained in the childcare center. This requirement was not met as evidenced by: Based on interviews, during a November 2021 inspection, approximately four child files were missing from the facility.	1 2 3 4 5 6 7	Per Assistant Director the files were replaced and all files are accounted for. Assistant Director stated emergency contact information is located within a separate file at the facility for emergency use. LPA observed all children present today had a file. No further action required.
	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: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3